Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity.
To ascertain morbidity and disability associated with vigorous attempts at limb salvage after lower extremity combined orthopedic and arterial injuries we reviewed more than 10,000 trauma admissions. Twenty-two patients (0.2%) suffered 14 blunt and eight penetrating lower extremity orthoarterial injuries. In all, more than 90 extremity operations were performed within 30 days of admission. The mechanism of injury, ISS, sequence of orthopedic and vascular procedures, use of temporary arterial shunts, the nature of the arterial reconstruction, length of ischemic time, and the presence of open fractures did not affect limb salvage or outcome. The presence of neurosensory/motor impairment and/or serious soft-tissue loss and injuries at or distal to the popliteal artery were associated with a high frequency of disability and amputation. Tremendous effort was expended to achieve limb salvage in the patients of this review. Patients who underwent amputation had the more uneventful hospitalizations and the lower rates of disability. The notion that limb salvage need to be obtained in all patients at all costs may often lead to the triumph of technique and technology over reason.