Predictors of Peripheral Vascular Injury in Patients with Blunt Lower Extremity Fractures.

BACKGROUND: Early identification of peripheral vascular injuries is crucial to prevent acute limb ischemia and amputation. We sought to identify predictors of vascular injury in patients with blunt lower extremity fractures.

METHODS: A single institutional retrospective analysis of patients with blunt lower extremity fractures at a university-affiliated, County hospital over a 2-year period was performed. Patients with lower extremity vascular injury were compared to patients without. Multivariate logistic regression analysis was performed to identify independent predictors of vascular injury.

RESULTS: Two hundred and seventy-four patients were identified. The mean age was 37.2 ± 17.6 years and 73.7% were male. The most common mechanisms were auto vs. pedestrian/bicycle (44.2%) and motor vehicle accidents (27.7%). Twenty-two patients (8.0%) had vascular injuries, of which the most commonly injured arteries were: the anterior tibial artery (8, 36.4%) and the posterior tibial artery (8, 36.4%). Patients with vascular injuries were more likely to have a tibia-fibula fracture (90.9% vs 52.4%, p < 0.01), an open fracture (63.6% vs 21.8%, p < 0.01), and a mid-shaft fracture (59.1% vs 19.4%, p<0.01). Amputation was required in 3 patients (13.6%) with a vascular injury. On multivariate analysis, a tibia-fibula fracture (OR=5.48, 95% CI= 1.15-26.1, p<0.05), an open fracture (OR=3.87, 95% CI= 1.37-11.0, p=0.01) and mid-shaft fracture (OR=2.91, 95% CI=1.04-8.1, p <0.05) were associated with the presence of a vascular injury.

CONCLUSION: Open tibia-fibula fractures particularly those involving a mid-shaft location are independent predictors of vascular injuries in patients with blunt lower extremity fracture. These findings may help identify patients requiring diagnostic and surgical intervention.