Vascular injury associated with fracture-dislocations of the lower extremity.

Vascular damage occurring in conjunction with orthopedic injury of the lower extremity is uncommon. This relative rarity is further complicated by the potentially subtle nature of vascular injury. Doppler signals and even palpable pulses do not exclude vascular damage. Missed or delayed diagnosis with a subsequent avoidable amputation is a too-frequent result. Displaced fractures of the distal femur and proximal tibia and particularly dislocation of the knee are associated with the highest risk of concomitant vascular injury and the poorest collateral circulation to support the distal limb. Optimal management of such injuries requires a high index of suspicion, aggressive use of angiography, and close cooperation among all members of the trauma team. With proper care, few extremities will be lost to ischemia alone. Limb loss should result only when the extremity has been too badly damaged to justify salvage efforts.