15. Diagnosis
• Physical exam
• Doppler pressure (Ankle/brachial
systolic pressure index)
• Duplex scanning
• Arteriogram
• Exploration Careful physical exam and
high index of suspicion are
most important !
16. Physical exam
• Major hemorrhage/hypotension
• Arterial bleeding
• Expanding hematoma
• Altered distal pulses
• Pallor
• Temperature differential between extremities
• Injury to anatomically-related nerve
18. Doppler ultrasound
• Determine presence/absence of arterial supply
• Assess adequacy of flow
PRESENCE OF SIGNAL DOES NOT
EXCLUDE ARTERIAL INJURY !
19. Doppler ultrasound
• Normal > 0.95
• Abnormal < 0.90
• Does not define extent or level of injury
• Abnormal values warrant further evaluation
Mills, et al. J. Trauma 2004
26. Surgical exploration
Immediate exploration is indicated
for:
• Obvious arterial injury on exam
• No doppler signal
• Site of injury is apparent
• Prolonged warm ischemia time
27. No pulses Asymmetric pulses Normal exam
Reduce, stabilize, resuscitate
Injury
obvious
Multilevel
injury ?
Doppler
ABI >0.9ABI <0.9
Angiography
or duplex
Surgery
Observation
Modified from Brandyk, CORR 1005
30. Surgical considerations
• Who goes first?
• Temporary shunts
• Fracture stabilization techniques
• Salvage vs amputation
• Fasciotomies
31. Conclusions
• Potential exists with every orthopedic injury
• Uncommon
• Be aware of injuries associated
• Understand signs and symptoms of arterial injury
32. Conclusions
• Time is crucial
• Most important for diagnosis
– High index of suspicion
– Thorough physical exam
• Have a defined protocol/relationship with your
colleagues from vascular and trauma surgery
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