Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

• Main Authors: F. Gilbert, C. Schneemann, C. J. Scholz, R. Kickuth, R. H. Meffert, R. Wildenauer, U. Lorenz, R. Kellersmann, A. Busch
• Format: Article
• Language: English
• Published: BMC 2018-11-01
• Series: BMC Musculoskeletal Disorders
• Subjects: Fracture-associated vascular damage; Surgical trauma room; Extremity trauma; Pelvic trauma; Endovascular repair; Level of evidence: IV
• Online Access: http://link.springer.com/article/10.1186/s12891-018-2333-y

Abstract Background Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. Methods This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. Conclusion Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.