Vascular injury means injury to blood vessels. both arteries and veins form blood vessel but when term vascular injury is used it always denotes injury to artery.
With any displaced fracture in the extremities, vascular injury can occur. When it occurs, it demands urgent diagnosis and treatment.
Because vascular injury can have devastating effect on the outcome injury, it is important to be vigilant and look for intactness of vessels in all cases of extremity fractures. All cases of displaced fractures must be examined without fail for presence of pulses distal to the fracture site.
If pulses distal to the fracture site are absent, one must be alarmed and watch for presence of vascular injury.
Once recognized, prompt vascular reconstruction with reversed saphenous vein grafting or primary repair is indicated.
When palpable pulses are not identified in a patient who is not hypotensive, side to side or brachial-leg pressure indices with Doppler examination is indicated.
Doppler examination would suggest whether there is flow distal to the fracture site. If Doppler suggests decreased flow distally patient must be taken for emergent exploration with the use of intraoperative angiography.
In some cases where patient is hypotensive (i.e.has low blood pressure), palpable pulses would not be found. In such cases it is prudent to improve the patient status by treating hypotension and then palpate the vessels again.
In treatment, repair of the vessel is to be done along with fixation of fracture by suitable implant. Vessel is either repaired by primary repair or with saphenous vein graft. While former means stitching of the torn vessel, later means putting a vein graft between two ends of injured vessel. Graft is required in cases where the end to end repair is not possible.
Ideal expected outcome is restoration of circulation and union of fracture. But vessel repair may not always be successful.
In case the repair fails amputation of the limb becomes necessary.
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