Determining the prognosis for limb salvage in major vascular injuries with associated open tibial fractures.

Nineteen patients with open tibial fractures and associated arterial injuries were reviewed. Vascular injuries were documented by either arteriography (74%) or clinical examination and direct visualization of injuries intraoperatively. Arterial injuries were divided into those proximal to and those distal to the trifurcation. Proximal injuries involved the popliteal artery in all cases, whereas distal injuries involved the anterior tibial artery, posterior tibial artery, peroneal artery, or combinations of these arteries. All patients' limbs were initially considered salvageable. The eventual amputation rate was 58%. The Mangle Extremity Severity Scores ranged from 4 to 9, and Gustilo's open fracture classification system included 21% Type IIIB and 79% Type IIIC injuries. An isolated anterior tibial artery or peroneal artery injury had a good prognosis. A poor outcome was correlated with posterior tibial artery and popliteal artery injuries and injuries involving all three major distal trifurcation arteries simultaneously. These findings were statistically significant (P less than .05). Traditional criteria for primary amputation are reviewed, and the relevance of a varied prognosis with specific vascular injuries is discussed.