Combined Orthopaedic and Vascular Injuries with Ischemia: A Multicenter Analysis.

Objectives To review a large, multicenter experience to identify the current salvage and amputation rates of these combined injuries and where possible, the variables that predict amputation. Design Retrospective. Setting Nice trauma centers. Patients 199 patients presenting to 9 trauma centers with orthopaedic and vascular injuries resulting in ischemic limbs for whom the orthopaedic service was involved with the decision for salvage vs. amputation. Results We reviewed 199 patients, aged 17-85 years. 172 of the injuries were open. Thirty-eight (19%) were treated with amputation upon admission as they were deemed to be unsalvageable. Of the remaining 161 who had attempted salvage, 36 (30%) required late amputation. Closed injuries were successfully salvaged in 25/27 cases (93%). The highest rate of amputation was in tibia fractures with a combined amputation rate of 62%. In those attempted to be salvaged, 21/48 (44%) required amputation. The ischemia time for successful salvage was significantly less, p = 0.03. 124 patients had their definitive vascular repair prior to the bony reconstruction. There were 15 vascular complications, of which 13 (86%) had the definitive vascular repair performed prior to the definitive osseous repair, although this was not statistically significant. Conclusions In this series of combined orthopaedic and vascular injuries, we found a high rate of acute and late amputations. It is possible that other protocols, such as shunting and stabilizing the osseous injury prior to vascular repair may benefit limb salvage, although this needs more study. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.