Arterial injuries associated with fractures of the lower limbs in childhood.

Three children with arterial injuries associated with fractures of the lower limb were treated by vascular reconstruction. Initial damage was more extensive than was macroscopically apparent and rethrombosis immediately followed thrombectomy or resection of a short segment of artery. When the extent of adventitial damage was used as a guide to the length of artery to be resected, permanent restoration of the circulation was achieved. Decompression of the four fascial compartments of the leg was performed in each child. Decompression through the fibular periosteum, leaving the fibula intact, gave a better cosmetic result than methods requiring multiple skin incisions. In each child the circulation was restored within six hours. Normal limb function and growth was achieved in two children and the residual abnormalities in the third child were the result of direct injury to muscle and growth plate.