How common are vascular injuries in open tibial fractures? A prospective longitudinal cohort study
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ORIGINAL ARTICLE • LOWER LIMB - FRACT URE S
How common are vascular injuries in open tibial fractures? A prospective longitudinal cohort study O. O’Malley1 · A. J. Trompeter1 · S. Krishnanandan1 · M. Vesely1 · P. Holt1 · G. Goh2 · N. Papadakos1 · V. Bhatia3 · C. B. Hing1 Received: 21 November 2018 / Accepted: 5 March 2019 © The Author(s) 2019
Abstract Background Tibial fractures have an incidence of 15% of all adult fractures. They have been shown to have the highest incidence of non-union in long bone fractures and the highest incidence of vascular injury. Evidence from the literature suggests that a good vascular supply is important to ensure bone union. The aim of our study was to prospectively assess the incidence of vascular injuries in open tibial fractures and determine whether they were associated with an increased risk of non-union. Methods We performed a prospective study to investigate the incidence of arterial injuries with computed tomography angiography (CTA) in patients with Gustilo–Anderson grade I–III open tibial fractures between 2013 and 2015. CTA was performed with the trauma series at acute admission and reported by two independent musculoskeletal radiologists. Patients were followed up with clinical and radiographic assessment for 1 year. Results We recruited 77 patients into the study, and 56 patients (47 males, 9 females) were available for the final analysis, between 16 and 90 years of age. At the initial assessment, 29% had signs of arterial injury with active extravasation in 5%. The most common site of injury was in the diaphysis (87.5%), and the commonest mechanism was a road traffic accident. We found no significant relation between occult vascular injury and non-union (p > 0.05). Conclusion The incidence of vascular injury in open tibial fractures is 29%, and CTA is therefore a useful test in identifying vascular injuries that may require vascular intervention. Keywords Tibia · Angiogram · Vascular injury
Introduction Tibial shaft fractures have an incidence of 15% of all adult fractures and are high-energy injuries often associated with significant soft tissue injury [1]. The main aims of treatment are to restore alignment of the tibia with adequate stability to allow bone union and rehabilitation of the limb. In the United Kingdom (UK), treatment follows the British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines of a * O. O’Malley [email protected] 1
Department of Trauma and Orthopaedics, St George’s University Hospitals NHS Foundation Trust, London, UK
2
Department of Radiology, The Alfred Hospital, Melbourne, Australia
3
St George’s University London, St George’s University Hospitals NHS Foundation Trust, London, UK
combined orthoplastic approach to management in regional specialist centres [2, 3]. Evidence from the literature suggests that a good vascular supply is important to ensure bone union with vascular compromise being implicated in non-union [4–7]. Tibial fractures have bee
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