Case Report
Volume 13 Issue 9 - 2022
Acute Limb Ischemia: An Uncommon Complication of Long Bone Fracture
Dabeluchi Chiedozie Ngwu1,2and Nicholas A Kerna3,4*
1Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Federal Medical Center, Umuahia, Nigeria
2Earthwide Surgical Missions, Nigeria
3Independent Global Medical Research Consortium, Thailand
4First InterHealth Group, Thailand
*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Received: August 18, 2022; Published: August 30, 2022


Introduction: Vascular injuries associated with limb bone fractures are surprisingly uncommon, with a reported incidence of less than 3% [1]. When these injuries occur, there is a threat to the life of the affected limb and the patient. Delay in diagnosis of concomitant vascular trauma is the leading cause of amputation in this limb-threatening (and life-threatening) injury.

Case Report: A 52-year-old victim of a pedestrian-motor vehicle crash was brought to our emergency room about an hour after the incident. History, tests, and imaging corroborated the diagnosis, and treatment ensued. The result 6 months later is of a well-perfused, sensate left leg and foot with good motor functions; the contralateral tibia/fibular fracture has also shown good union, and he is currently undergoing rehabilitation on an outpatient basis.

Discussion: The mechanism of vascular injury caused by blunt trauma involves vascular occlusion secondary to thrombi of the ruptured vascular intima [3]. The threat in this setting is not only to the life of the affected limb but also to the injured individual's life. Therefore, in managing vascular injuries associated with fractures, the principles of resuscitation, early and accurate diagnosis, revascularization, soft tissue preservation, and fracture stabilization should be pursued as much as possible. Physical findings of hard signs of arterial injury are usually sufficient for preoperative diagnosis. However, angiography becomes necessary in cases of uncertain presence of distal pulse and especially in cases of blunt trauma. Classical angiography, however, leads to 1 – 2 hours of wasted time and may lead to the aggravation of ischemic severity. Single shot angiography in the operating room avoids such wasting of time.

Conclusion: A limb fracture with concomitant arterial injury puts the life of the limb and the patient at significant risk. The gross features of distal ischemia in a patient with a limb fracture should alert the clinician immediately to potential associated arterial injury, allowing for prompt resuscitation, evaluation, and repair—often without further diagnostic tests.

Keywords: Amputation; Compartment Syndrome; Popliteal Fossa; Vascular Injury


  1. Katsamouris AN., et al. “Limb arterial injuries associated with limb fractures: Clinical presentation, assessment and management”. European Journal of Vascular and Endovascular Surgery 1 (1995): 64-70.
  2. Ganie FA., et al. “The Increas-ing Rate of Secondary Amputation in Popliteal Arterial Injury Associated with Multi-Organ Injuries and Hypotension”. International Cardiovascular Research Journal 4 (2012): 124-127.
  3. Imerci A., et al. “Popliteal Artery Injury Associated with Blunt Trauma to the Knee without Frac-ture or Dislocation”. Western Journal of Emergency Medicine 2 (2014): 145-148.
  4. Subasi M., et al. “Popliteal artery injuries associated with fractures and dislocations about the knee”. Acta Orthopaedica Belgica 3 (2001): 259-266.
  5. Kauvar DS., et al. “National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma”. Journal of Vascular Surgery6 (2011): 1598-1603.
  6. Cakir O., et al. “Treatment of vascular injuries asso-ciated with limb fractures”. Annals of The Royal College of Surgeons of England 5 (2005): 348-352.
  7. Martin LC., et al. “Man-agement of lower extremity arterial trauma”. The Journal of Trauma and Acute Care Surgery 4 (1994): 598-599.
  8. Pretre R., et al. “Lower limb trauma with injury to the popliteal vessels”. The Journal of Trauma and Acute Care Surgery 4 (1996): 595-601.
  9. Melton SM., et al. “Popliteal artery trauma systemic anticoagulation and intraoperative thrombolysis improves limb salvage”. Annals of Surgery 5 (1997): 518-527.
  10. Keeley J., et al. “Factors Associated with Amputation after Popliteal Vascular Injuries”. Annals of Vascular Surgery 33 (2016): 83-87.
  11. Asensio JA., et al. “Popliteal artery injuries. Less ischemic time may lead to improved outcomes”. Injury 11 (2020): 2524-2531.
  12. Pechar J and Lyons MM. “Acute Compartment Syndrome of the Lower Leg: A Review”. The Journal for Nurse Practitioners 4 (2016): 265-270.
Citation: : Dabeluchi Chiedozie Ngwu and Nicholas A Kerna. “Acute Limb Ischemia: An Uncommon Complication of Long Bone Fracture”. EC Orthopaedics 13.8 (2022): 86-92.

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