Stefanou N, Arnaoutoglou C, Papageorgiou F, Matsagkas M, Varitimidis SE, Dailiana ZH. Update in combined musculoskeletal and vascular injuries of the extremities. World J Orthop 2022; 13(5): 411-426 [PMID: 35633747 DOI: 10.5312/wjo.v13.i5.411]
Corresponding Author of This Article
Zoe H Dailiana, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, No. 3 Panepistimiou Street, Biopolis, Larissa 41500, Greece. dailiana@med.uth.gr
Research Domain of This Article
Orthopedics
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2022; 13(5): 411-426 Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.411
Update in combined musculoskeletal and vascular injuries of the extremities
Nikolaos Stefanou, Christina Arnaoutoglou, Fotios Papageorgiou, Miltiadis Matsagkas, Sokratis E Varitimidis, Zoe H Dailiana
Nikolaos Stefanou, Christina Arnaoutoglou, Fotios Papageorgiou, Sokratis E Varitimidis, Zoe H Dailiana, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
Miltiadis Matsagkas, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
Zoe H Dailiana, Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Larissa 41500, Greece
Author contributions: Stefanou N, Papageorgiou F and Dailiana ZH wrote the paper; Stefanou N, Arnaoutoglou C and Dailiana ZH participated in the conception and design of the study; Stefanou N, Arnaoutoglou C, Papageorgiou F and Dailiana ZH participated in the analysis and drafting of the literature data; Matsagkas M, Varitimidis S and Dailiana ZH participated in critical revision of the article; Varitimidis S, Dailiana ZH participated in the analysis and interpretation of the literature data; All authors read and approved the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zoe H Dailiana, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, No. 3 Panepistimiou Street, Biopolis, Larissa 41500, Greece. dailiana@med.uth.gr
Received: February 25, 2021 Peer-review started: February 25, 2021 First decision: October 17, 2021 Revised: October 31, 2021 Accepted: April 24, 2022 Article in press: April 24, 2022 Published online: May 18, 2022
Abstract
Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily. Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage, duration of limb ischemia, patient’s medical status and presence of associated injuries. The management of these injuries is challenging and requires a specific algorithm of action, because they are usually characterized by increased morbidity, amputation rate, infection, neurological and functional deficits, and they could be life threatening. Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma, the high index of suspicion, imaging control, and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases. Even after a successful initial treatment of a combined trauma pattern, long-term follow-up is crucial to prevent and detect early possible complications. The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities, from an orthopedic point of view.
Core Tip: A complex extremity injury that, in addition to a fracture, dislocation or even crush, involves a vascular injury represents a rare trauma pattern. Historically, control of hemorrhage following trauma has been of interest as far as vascular injury is a leading cause of death and disability. We here discuss the epidemiology, diagnosis and team management of combined musculoskeletal and vascular injuries of the extremities.
