Combined Orthopedic and Vascular Lower Extremity Injuries: Sequence of Care and Outcomes

Combined vascular and orthopedic injuries requiring repair are rare. However, these injuries have a high amputation rate and significant morbidity.

In a retrospective review of lower extremity injuries managed at a level I trauma center over 9 years, we identified 26 patients with com­bined vascular and orthopedic inju­ries. We evaluated their rates of amputation and revascularization procedures based on sequence of care and initial intervention. Patients were stratified into 3 groups based on the initial intervention given: definitive vascular repair (n = 17), orthopedic stabilization (n = 4), and temporary shunt (n = 5).

Amputation rates were 29% (5/17) in the vascular group and 20% (1/5) in the shunt group; there were no amputations in the orthopedic group (0/4). Revascularization rates were 41% (7/17), 25% (1/4), and 20% (1/5) in the vascular, orthope­dic, and shunt group, respectively. Mangled Extremity Severity Scores higher than 6 had an overall relative risk of 5.5 for amputation (P<.05).

We conclude that temporary vas­cular shunting followed by ortho­pedic stabilization and then defin­itive vascular repair is the most reasonable sequence of care for minimizing rates of amputation and revascularization procedures in this cohort of patients.