Blunt Extremity Trauma Research Articles

Comparison of Outcome in Upper and Lower Limb Blunt Arterial Trauma: A Single-Center Experience

Introduction - In literature, data reporting on outcome after repair of arterial limb trauma frequently include and combine upper (UE) and lower (LE) extremity lesions as well as blunt and penetrating mechanisms. However, outcome analyses in such combined cohorts depend on the case mix and may not be comparable in upper and lower limb lesions. We hereby report on our experience and the differences in upper and lower limb blunt trauma in our large European Level I Trauma Centre. Methods - All patients that underwent repair of main arteries in the upper (axillary artery or distal) or lower (common femoral artery or distal) limb for blunt traumatic injuries since 1990 were included and retrospectively analysed. Exclusion criteria were: iatrogenic and penetrating injuries; more proximally located lesions (e.g. to subclavian artery or iliac arteries); posttraumatic aneurysms; ligation or occlusion (e.g. endovascular coil embolization) and / or conservatively managed injuries. Endpoints of outcome analysis were: in-hospital mortality; limb loss; early vascular re-intervention (within initial hospital stay); length of hospital stay. Descriptive statistics was performed. For comparison of categorical variables, Fisher´s Exact test was used; for continuous variables Mann-Whitney U test was performed; both were considered significant if P<0.05. Results - A total of 204 patients underwent repair of blunt arterial injuries to the UE (n=88) or LE (n=116). Distribution of age (UE: median: 35.7 yrs [range: 2.5-80.5]; LE: 33.4 [5.3-84.4]) and gender (UE: 80.7% male; LE: 80.2%) was similar. Injuries were most frequently located in the brachial (58% of all UE lesions) or the popliteal (51% of all LE lesions) artery. Associated lesions were frequently seen, and included skeletal (UE: 77.3% vs. LE: 85.3%; P=.15) and / or nerve injuries (UE: 38.6% vs. LE: 25.9%; P=.07). Arterial repair was achieved using various types of surgery (direct suture, patchplasty, end-to-end anastomosis or interposition grafts), most frequently autologous vein graft interposition (UE: 73.9%; LE: 75.9%). None of the patients underwent endovascular treatment. In-hospital mortality was 3.4% in UE vs. 7.8% in LE trauma (P=.24). Limb loss rate was significantly higher in the lower limb (UE: 4.5%; LE: 15.5%; P<.05). Early vascular re-intervention rate due to early graft occlusions was 8% (UE) vs. 9.5% (LE) (P=.81). Length of hospital stay was significantly longer in lower limb arterial injuries (UE: median: 10 days [range: 2-17]; LE: 25 [7-132]) (P<.001). Conclusion - Our cohort analysis indicates that outcome after arterial repair in blunt extremity trauma differs between upper and lower extremity: Limb loss rate is significantly higher in lower limbs, and so is length of hospital stay. Noteworthy, early graft occlusions occurred in up to 10% with similar rates in upper and lower limb. In general, outcome data after arterial repair in limb trauma largely depend on associated injuries and the case-mix. Analyses of outcome data (e.g. on limb salvage rates) in combined upper and lower limb cohorts, as frequently shown in literature, are inappropriate.

A case report; Damage Control Transcatheter Arterial Embolization was Very Effective for Massive Hemorrhage due to Rupture of the Axillary Artery from Blunt Extremity Trauma

A case report; Damage Control Transcatheter Arterial Embolization was Very Effective for Massive Hemorrhage due to Rupture of the Axillary Artery from Blunt Extremity Trauma

Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

BackgroundTraumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated.MethodsIn a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS), diagnostic and therapeutic management, complications and outcome were evaluated.ResultsThe most commonly injured vessel was the femoral artery (25%) followed by the brachial artery (22.7%). The mechanism of injury was penetrating (31.8%), isolated severe blunt extremity trauma (29.6%), multiple trauma (25%) and humeral supracondylar fractures (13.6%). In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%). A MESS < 7 was associated with initial (p < 0.05) and definite limb salvage (p < 0.001) of the lower extremity.ConclusionsTraumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.

Screening for extermity arterial injury with the arterial injury with the arterial pressure index

Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted. The diagnostic strategies for vascular injury have undergone an evolution over the past 2 decades. One and a half percent to 4.6% of patients hospitalized with blunt extremity trauma have associated vascular compromise [Bunt TJ, Malone JM, Moody M, et al. Am J Surg 1990;160(2):226-8; Reid JD, Weigelt JA, Thal ER, et al. Arch Surg 1988;123(8):942-6; Applebaum R, Yellin AE, Weaver FA, et al. Am J Surg 1990;160(2):221-4; discussion 224-5; Dennis JW, Frykberg ER, Veldenz HC, et al. J Trauma 1998;44(2):243-52; discussion 242-3]. An efficient and effective evidence-based approach to diagnosing vascular injury is necessary, as the difficulty in diagnosis, the multiplicity of diagnostic strategies, the limited time frame in which to initiate appropriate treatment, the limb threatening complications of a missed diagnosis, and the increased awareness of health care expenditures make this entity an intimidating diagnostic challenge [Johansen K, Lynch K, Paun M, et al. J Trauma 1991;31(4):515-9; discussion 519-22; Lynch K, Johansen K. Ann Surg 1991;214(6):737-41; Walker ML, Poindexter Jr JM, Stovall I. Surg Gynecol Obstet 1990;170(2):97-105; Kendall RW, Taylor DC, Salvian AJ, et al. J Trauma 1993;35(6):875-8]. The purpose of this article is to present an evidence-based algorithm for patients who present with either arterial injury or a high-risk of arterial injury. A diagnostic algorithm will be presented, and the rationale for diagnostic interventions will be discussed in the context of current medical literature.

Outcome and utility of scoring systems in the management of the mangled extremity

The role of scoring systems as predictors of amputation and functional outcome in severe blunt extremity trauma was examined. All severe extremity injuries treated over a 10-year period were scored retrospectively using four scoring systems: Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and Limb Salvage Index (LSI). Twenty-three upper (UE) and 51 lower extremity (LE) injuries were evaluated. Sensitivity and specificity, respectively, were MESI 100% and 50%, MESS 79% and 83%, PSI 96% and 50%, and LSI 83% and 83%. For each system, there were no differences between patients with good and poor functional outcomes. All of the scoring systems were able to identify the majority of patients who required amputation. However, prediction in individual patients was problematic. None of the scoring systems were able to predict functional outcome.

The management of venous injuries in blunt extremity trauma: Ross SE, Ransom KJ, Shatney CH J Trauma 25:150–152 Feb 1985

The management of venous injuries in blunt extremity trauma: Ross SE, Ransom KJ, Shatney CH J Trauma 25:150–152 Feb 1985

Venous injuries : Ross S. E., Ransom K. J. and Shatney C. H. (1985) The management of venous injuries in blunt extremity trauma. J. Trauma25, 150

Venous injuries : Ross S. E., Ransom K. J. and Shatney C. H. (1985) The management of venous injuries in blunt extremity trauma. J. Trauma25, 150

The management of venous injuries in blunt extremity trauma.

Data on venous injury in blunt extremity trauma are scarce. The nature of injury and results of therapy in 22 patients presenting with blunt venous extremity injury at MIEMSS and KUMC in a 10-year period are presented. Comparisons of the outcome with venous ligation and repair, the use of anticoagulants, and the use of fasciotomy, led to the development of guidelines for the therapy of blunt venous injury in both upper and lower extremity trauma.