Two-team management of vascular injuries concomitant with osteo-articular injuries in 36 patients over six years

Background: Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice. Hypothesis: The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries. Material and methods: A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries. Results: The study included 36 patients with a mean age of 40.6 +/- 22.1 years. The main sources of injury were traffic accidents (n= 19, 52.8%), crush injury (n=8, 22.2%), and falls (n= 5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11(30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11(30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0-74.8] months. Discussion: Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury. (C) 2018 Elsevier Masson SAS. All rights reserved.