Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
Introduction:
Early detection and intervention can reduce the complications associated with vascular injuries in lower extremity (LE) fractures. Computed tomography angiography (CTA) is commonly performed in trauma patients with open LE fractures. However, there is no evidence supporting routine CTAs or consensus on CTA utilization in the absence of clinical signs of vascular injury. This study aimed to identify injury characteristics associated with vascular injury and the need for vascular surgical intervention in trauma patients with open LE fractures, while also investigating CTA utilization.
Methods:
A retrospective review was conducted on patients with open fractures of the tibia, fibula, and femur treated at a level I trauma center between March 2014 and March 2019. Patients under 18 years old, pregnant individuals, those with pathologic fractures, or those treated at outside hospitals were excluded. Demographic and clinical data were collected from the institution’s electronic medical record (EMR) and analyzed.
Results:
Among 135 patients, 42 (31.1%) underwent CTA evaluation, 11 (8.1%) had positive CTAs, and five (3.7%) required vascular surgical intervention. Patients who underwent CTA evaluation (p=0.003, p=0.004), those with positive CTA findings (p=0.038, p< 0.001), and those who required vascular surgery (p=0.006, p< 0.001) were each significantly more likely to present with compartment syndrome and hard signs of vascular injury compared to their respective counterparts. Of the 42 patients evaluated with CTA, 22 (52.4%) showed no signs of vascular injury. All patients who underwent vascular surgery had both hard signs of vascular injury and positive CTAs, except one in which the vascular injury was diagnosed intraoperatively.
Discussion:
This study found a low incidence of vascular injury in patients with open LE fractures, with an even lower rate requiring vascular surgery. However, nearly one-third of the included patients underwent CTA evaluation. Among those that had a CTA, more than half had no signs of vascular injury at presentation. Clinical signs should be considered when deciding to perform CTA to minimize its overuse in trauma patients with open LE fractures.
Embargo Period
5-29-2025
Included in
Injury characteristics associated with vascular injuries in trauma patients with open lower extremity fractures: Are we overutilizing CT angiography?
Philadelphia, PA
Introduction:
Early detection and intervention can reduce the complications associated with vascular injuries in lower extremity (LE) fractures. Computed tomography angiography (CTA) is commonly performed in trauma patients with open LE fractures. However, there is no evidence supporting routine CTAs or consensus on CTA utilization in the absence of clinical signs of vascular injury. This study aimed to identify injury characteristics associated with vascular injury and the need for vascular surgical intervention in trauma patients with open LE fractures, while also investigating CTA utilization.
Methods:
A retrospective review was conducted on patients with open fractures of the tibia, fibula, and femur treated at a level I trauma center between March 2014 and March 2019. Patients under 18 years old, pregnant individuals, those with pathologic fractures, or those treated at outside hospitals were excluded. Demographic and clinical data were collected from the institution’s electronic medical record (EMR) and analyzed.
Results:
Among 135 patients, 42 (31.1%) underwent CTA evaluation, 11 (8.1%) had positive CTAs, and five (3.7%) required vascular surgical intervention. Patients who underwent CTA evaluation (p=0.003, p=0.004), those with positive CTA findings (p=0.038, p< 0.001), and those who required vascular surgery (p=0.006, p< 0.001) were each significantly more likely to present with compartment syndrome and hard signs of vascular injury compared to their respective counterparts. Of the 42 patients evaluated with CTA, 22 (52.4%) showed no signs of vascular injury. All patients who underwent vascular surgery had both hard signs of vascular injury and positive CTAs, except one in which the vascular injury was diagnosed intraoperatively.
Discussion:
This study found a low incidence of vascular injury in patients with open LE fractures, with an even lower rate requiring vascular surgery. However, nearly one-third of the included patients underwent CTA evaluation. Among those that had a CTA, more than half had no signs of vascular injury at presentation. Clinical signs should be considered when deciding to perform CTA to minimize its overuse in trauma patients with open LE fractures.