Incidence and Outcomes of Vascular Injury in the Setting of Tibial Plateau Fractures: A Single-Center Review

Abstract

Objectives: Vascular surgeons are frequently consulted to evaluate hospitalized patients with finger ischemia. We sought to characterized causes and outcomes of finger ischemia in intensive care unit (ICU) patients. Methods: ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger plethysmography (PPG). Patient demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were recorded. ICU patients were compared to concurrently evaluated non-ICU inpatients with finger ischemia. Results: We identified 97 ICU patients (54 men, 43 women). Mean age was 57 6 17 years. Forty-three percent were in the surgical and 57% in the medical ICU. Seventy-two percent had abnormal finger PPGs, 69% unilateral and 31% bilateral. Thirty-seven percent had a radial arterial line. Thirteen percent had concomitant toe ischemia. Seventy-eight percent were on vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (30%), epinephrine (26%), and vasopressin (25%). Treatment was with therapeutic anticoagulation in 47%, aspirin in 52%, and clopidogrel in 16%. Other frequent associated conditions included mechanical ventilation (37%), diabetes (33%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Five patients required finger amputation. Survival was 85% at 30 days, 73% at 1 year, and 65% at 2 years. By Cox modelling, cancer (hazard ratio, 6.3; P ¼ .012) and dialysis (hazard ratio, 4.9; P ¼ .026) were independent predictors of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P ¼ .05), be on antibiotics (38% vs 14%; P ¼ .02), and undergo finger amputations (16% vs 5%; P ¼ .03). Conclusions: Finger ischemia in ICU patients is often associated with the arterial lines and vasoactive medications, with phenylephrine and norepinephrine the most common. While progression to amputation is rare, patients with finger ischemia in the ICU have high mortality, particularly in the presence of cancer or dialysis. Non-ICU patients with finger ischemia more often require amputations, likely due to more frequent connective tissue disorders and finger infections.

Popliteal Artery Entrapment within a Tibial Plateau Fracture

“…T he concern for the dysvascular limb or vascular injury within the setting of a tibial plateau fracture is a common reason for consulting vascular surgery service 1 . The incidence of tibial plateau fractures is approximately 1.2% of all fractures, and high-energy trauma, such as falls or motor vehicle collisions, is the usual cause 2 .…”