Arterial lesions accompanying fractures and luxations

We analyzed reasons, numbers and results of arterial lesions accompanying f ractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retr ospectively Traffic accidents were in nearly 50 % responsible for the injur ies. 8 patients had suffered multiple injuries. In 17 patients the lower, a nd in 10 patients the upper extremities were affected. The vascular wall wa s completely disrupted or severed in 74 %. In 7 cases (26 %), patients had suffered blunt or indirect arterial trauma with intima- and media-laceratio ns due to subcapital fracture of the humerus (n = 2), fractured femoral bon e (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mea n preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in pa tients with complete ischaemia. Vascular reconstruction was performed by in terposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a ve nous patch plasty (n = 2) and, in a single case, by autologous bypass proce dure. In one case, a crural artery was ligated, in another case with a Mang led Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were pe rformed. No patient died. The final outcome is mostly influenced by the pre operative period of ischaemia.