Combined severe vascular and skeletal trauma. Management and results.

The viability and final functional ability of a limb following a vascular trauma will depend upon many factors, among these are the associated injuries. Thirty three patients suffering from combined vascular and skeletal injuries are presented. The presence of associated fractures weighed heavily upon the prognosis in these patients. Thus, twelve patients, or 36.3%, underwent limb amputation. Two patients died. In war wounds, the high velocity missile had caused severe and extensive destruction of tissues and the presence of the skeletal injury reflected well the degree of severity of the injury sustained by many of these wounded. The site of the fracture had a definite influence on the prognosis. For instance, all patients with a popliteal vessel injury lost their limb. The post operative complications noted in this series were essentially infectious complications. Internal fixation of the fracture, when used, was followed by a 45% rate of infection against a 27% rate when external fixation had been used. A higher rate of amputation was however observed in patients who had external fixation of the fracture (45.3%) rather than in those with internal fixation of the fracture (45.3%) rather than in those with internal fixation (30%). This is explained by the severity of the injury sustained in the former group. Nineteen patients were discharged with a viable limb, a success rate of 57.5%. The functional result was excellent in thirteen patients only (39.3%). Six patients remained with residual functional disability due to the associated injuries.