Update in combined musculoskeletal and vascular injuries of the extremities

Abstract

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily. Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage, duration of limb ischemia, patient’s medical status and presence of associated injuries. The management of these injuries is challenging and requires a specific algorithm of action, because they are usually characterized by increased morbidity, amputation rate, infection, neurological and functional deficits, and they could be life threatening. Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma, the high index of suspicion, imaging control, and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases. Even after a successful initial treatment of a combined trauma pattern, long-term follow-up is crucial to prevent and detect early possible complications. The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities, from an orthopedic point of view.

Keywords: Vascular injury; Musculoskeletal trauma; Combined injury; Arterial injury; Mangled extremity; Limb salvage

Core Tip: A complex extremity injury that, in addition to a fracture, dislocation or even crush, involves a vascular injury represents a rare trauma pattern. Historically, control of hemorrhage following trauma has been of interest as far as vascular injury is a leading cause of death and disability. We here discuss the epidemiology, diagnosis and team management of combined musculoskeletal and vascular injuries of the extremities.