Epidemiology of lower limb musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India

Abstract

Background:Vascular trauma associated with bony injuries is an orthopaedic emergency. Lack of timely intervention can lead to loss of limb or even life. Inspite of the rising incidence of high speed road traffic accidents in India, there is paucity of literature regarding the demographic pattern, clinical morbidity, management strategies and outcome of arterial injuries associated with lower limb trauma. The aim of this study is to describe the epidemiology and outcome of lower extremity musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India.Materials and Methods:All individuals who presented to our tertiary care trauma center from July 2013 to December 2014 with lower extremity vascular injury associated with lower limb fractures were identified from a retrospective trauma database for this descriptive study. For the 17 months, there were 82 lower extremity vascular trauma cases admitted in our trauma center, of which 50 cases were included in the study. 32 patients with crush injuries, traumatic amputations, and those with head injury and blunt trauma to chest or abdomen were excluded from the study.Results:Out of the 50 cases of lower extremity vascular injury with associated lower limb fractures, 19 limbs were salvaged, 28 amputated, and three patients expired. Young males in the age group of 20–39 years were frequently injured. Motor vehicle accident (MVA) (82%) was found to be the most common cause followed by pedestrian injury. Popliteal artery (62%) was the most common vessel injured, followed by femoral artery (28%). The salvageability percentage was much higher (64%) in the femoral artery injury group when compared to popliteal artery injury group (25%). There were 32 open fractures, with amputation rates (60%) being higher and all three cases of death falling in this group. In addition, the limb salvageability percentage was 43.2% when the patient presented within 12 h of injury and this decreased to a mere 16.7% when the patient had presented more than 24 h after injury.Conclusion:MVAs are the leading cause of vascular injuries in India. Road safety measures and prevention programs are the need of the hour to prevent these kinds of injuries in the future.

Outcome of popliteal arterial injuries presenting to the Teaching Hospital, Anuradhapura

“…Such injuries are likely to have a major economic impact on young families. Similar data has been reported in other regional and international studies on injuries to PAs (1,2,3,4). Preventive measures targeting vulnerable motorcyclist needs emphasis.…”

Epidemiology of fractures during a peacekeeping mission in northern Mali

“…These fractures were often open. Frederico Carlos et al [10] , Nirmal Raj Gopinathan et al [11] reported respectively 73.5% and 64% of open fractures in their studies. The proximity of the lower limbs to the ground further exposes them to improvised explosive device explosions, resulting in many associated injuries and traumatic amputations.…”

Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

“…Las lesiones vasculares en los miembros inferiores tienen una tasa de amputación general del 11%. Las lesiones de la arterias femoral o poplítea tienen un riesgo de amputación del 28 al 37%, el cual puede incrementar hasta un 70% en las presentaciones tardías 24 - 28 .…”

“…Lower extremity vascular injuries have an overall amputation rate of 11%. Injuries of the popliteal or femoral arteries have an amputation risk of 28 to 37%, increasing up to 70% when there is a delay in presentation [24][25][26][27][28] .…”