Tibial shaft fractures with an associated infrapopliteal arterial injury: A survey of vascular surgeons' opinions on the need for vascular repair

Objective: To determine current practice for tibial arterial revascularizat ion in trauma patients with tibial shaft fractures associated with infrapop liteal arterial injuries. Design: Nationwide survey of board-certified vascular surgeons, proportiona lly stratified by geographic region. Methods: We surveyed a random sample (probability sample stratified by geog raphic region) of 200 members of the 729 active members of the Society for Clinical Vascular Surgery. We designed a twenty-one-item questionnaire to e licit opinions on the need for Vascular repair for a variety of clinical sc enarios. Results: Completed questionnaires were returned by fifty-one vascular surge ons. For the eight isolated and combined infrapopliteal arterial injuries w e studied, agreement between vascular surgeons as to the need for arterial repair was better for scenarios with clinical evidence of Limb ischemia tha n for those without clinical evidence of limb ischemia. For injuries with c linical evidence of limb ischemia, excellent agreement (90 percent or more of respondents agreeing) was seen for five of the eight injuries, good agre ement (80 to 89 percent of respondents agreeing) was seen for two injuries, and poor agreement (less than 70 percent of respondents agreeing) was seen for one injury. For injuries without clinical evidence of limb ischemia, e xcellent agreement was seen for one injury, good agreement was seen for two injuries, fair agreement (70 to 79 percent of respondents agreeing) was se en for three injuries, and poor agreement was seen for two injuries. Conclusions: A review of the literature and results of our study suggest th at no standardized protocol exists in the current practice of revasculariza tion of infrapopliteal arterial injuries with concomitant tibial shaft frac tures; disagreement among vascular surgeons was particularly common for cas es where a vessel was known to be injured but there was no clinical evidenc e of limb ischemia. Our study highlights the need for randomized prospectiv e studies so that standardized protocols can be developed for these serious injuries. Because of the relatively small numbers of this type of injury a nd the wide variety of injury patterns seen, a study such as this would bes t be designed as a multi-center study.