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Arterial injury
Volume 2 Number I
DWYER" PROTECTIVE INFLUENCE OF COMPRESSION
r e m a i n free f r o m the e n c u m b r a n c e o f a plaster-ofParis case. This, however, is usually subject to the patients' c o - o p e r a t i o n in a v o i d i n g u n d u e stress o n the affected limb, involving for example, n o n - or partial weight-bearing between crutches for a fractured tibia. If for a n y reason this c o - o p e r a t i o n is lost or if the p a t i e n t s h o u l d s t u m b l e a n d fall while unprotected by a cast, it w o u l d a p p e a r t h a t his fracture is safer if plated in compression. O n e c o m m o n objection to the use of r a b b i t s in this type of investigation, is t h a t their fractures unite far t o o easily a n d n e v e r go o n to n o n - or even delayed union, as d o h u m a n s . Possibly this is in part because, in these very active animals, all the potential n o n - or delayed u n i o n cases are c r e a m e d off in c o m p l e t e early failures. This suggests t h a t delayed u n i o n is sometimes a consequence o f insufficient rigidity o f fixation. If
25
this is true, t h e n it represents a n o t h e r benefit o f the c o m p r e s s i o n t e c h n i q u e applied to fixation o f fractures or osteotomies in long bones.
Acknowledgements I s h o u l d like to t h a n k Mr. J o s e p h Fejfar for his considerable technical help with p r e p a r a t i o n o f specimens, a n d Mr. A. W. F. Lettin for permission to use his design o f a p p a r a t u s . T h e study was m a d e possible by a generous g r a n t f r o m the B i r m i n g h a m Regional H o s p i t a l Board. REFERENCES LEYnN, A. W. F. (1965), ' The Effects of Axial Compression on the Healing of Experimental Fractures of the Rabbit Tibia ', Proc. R. Soc. Med., 58, 882. MOLLER, M. E., ALLGOWER, M., and WILLENEGGER, H. (1965), Technique o f hlternal Fixation o f Fractures. Berlin: Springer. RAHN, B. A. (1970), personal communication.
Requests for reprints shouMbe addressed to:--N. St. J. P. Dwyer, Esq., M.B., Ch.B.(Edin.), F.R.C.S.(Eng. and Edin.), Royal Orthopaedic Hospital, Northfield, Birmingham 3 I.
ABSTRACTS VASCULAR INJURIES
Vascular Injuries Eighteen cases of vascular injuries are described in detail, all of whom were men aged between 5 and 66 years. Six injuries were sustained in road accidents, 5 in the course of work, 6 were due to other forms of accident, and 1 due to an assault. The worst cases were those occurring in road accidents or at work where the whole limb was badly crushed with damage to skin, vessels, nerves, and bones. There were 8 cases where arterial injuries were uncomplicated and these comprised 1 case of direct contusion, 4 lacerated wounds, 1 stab wound, and 2 due to gunshot wounds. The other cases had associated injuries, in 3 of which there was compression of the artery by fracture; in 2 there were haematomata and in 2 the artery was divided by the fracture. In 4 others the artery was contused and all of these were complicated by thrombosis. There were 10 cases where the vascular injury was not complicated by any division of the vessel itself, 13 were closed injuries and 5 open. The arteries involved were 5 femoral, 5 popliteal, 4 brachial, 1 tibial, 1 radial, and 1 internal carotid. Results: Thirteen of the 18 cases had a complete restoration of anatomical and functional normality. One had a good anatomical recovery with some loss of function. One was followed by partial anatomical and functional disability and there were 3 total failures. The authors conclude that arteriography is important in diagnosing the exact nature and the site of the lesion. They advocate prompt surgical treatment of the majority of cases and do not feel that drug therapy using antispasmodics or anticoagulants has much place. RICCIARDI,L., and PETRASSI,A. (1969), ' Vascular Injuries ', Clinica ortop., 21, 203.
Arterial Injury Thirty arterial injuries over 10 years included 19 of iatrogenic origin, 6 from road accidents, and 2 sustained at work. Complicating lesions other than the arterial were present in 11 cases. Iatrogenic lesions were usually complications of arteriography. Fourteen cases were treated by primary operation, 5 by secondary operation, and 11 conservatively. There was 1 death and 2 cases of gangrene. MATHXESON, F. R. (1969), ' Acute Arterial Injuries in Civilian Practice ', Acta chir. scand., 135, 15. Arteriovenous Fistula From experience with 4 cases of arteriovenous fistula it appears that changes in the artery proximally become irreversible within a year. Early closure prevents this. LINDENAUER, S. M., THOMPSON, N. W., KRAFT, R. O., and FRY, W. J. (1969), ' Late Complications of Traumatic Arteriovenous Fistulas ', Surgery Gynec. Obstet., 129, 525. Arteriovenous Fistula after Laminectomy Angiography is necessary in confirming the diagnosis of an arteriovenous fistula following laminectomy and in demonstrating the nature and extent of the lesion. Trauma to the vessels is usually caused by a pituitary forceps passing through the anterior longitudinal ligament. Patients may present with cardiac failure in the immediate postoperative period. However, the symptoms and signs of a fistula may develop only after many months or years. Because of the rapid blood-flow through the arteriovenous shunt, the injection of a large bolus of contrast material is necessary. A case of arteriovenous fistula following lumbar disk surgery is presented. DAWES, J. M. C. (1969), ' Ilio-iliac Arteriovenous Fistula following Laminectomy ', Clin. Radiol., 20, 103.
DWYER" PROTECTIVE INFLUENCE OF COMPRESSION
r e m a i n free f r o m the e n c u m b r a n c e o f a plaster-ofParis case. This, however, is usually subject to the patients' c o - o p e r a t i o n in a v o i d i n g u n d u e stress o n the affected limb, involving for example, n o n - or partial weight-bearing between crutches for a fractured tibia. If for a n y reason this c o - o p e r a t i o n is lost or if the p a t i e n t s h o u l d s t u m b l e a n d fall while unprotected by a cast, it w o u l d a p p e a r t h a t his fracture is safer if plated in compression. O n e c o m m o n objection to the use of r a b b i t s in this type of investigation, is t h a t their fractures unite far t o o easily a n d n e v e r go o n to n o n - or even delayed union, as d o h u m a n s . Possibly this is in part because, in these very active animals, all the potential n o n - or delayed u n i o n cases are c r e a m e d off in c o m p l e t e early failures. This suggests t h a t delayed u n i o n is sometimes a consequence o f insufficient rigidity o f fixation. If
25
this is true, t h e n it represents a n o t h e r benefit o f the c o m p r e s s i o n t e c h n i q u e applied to fixation o f fractures or osteotomies in long bones.
Acknowledgements I s h o u l d like to t h a n k Mr. J o s e p h Fejfar for his considerable technical help with p r e p a r a t i o n o f specimens, a n d Mr. A. W. F. Lettin for permission to use his design o f a p p a r a t u s . T h e study was m a d e possible by a generous g r a n t f r o m the B i r m i n g h a m Regional H o s p i t a l Board. REFERENCES LEYnN, A. W. F. (1965), ' The Effects of Axial Compression on the Healing of Experimental Fractures of the Rabbit Tibia ', Proc. R. Soc. Med., 58, 882. MOLLER, M. E., ALLGOWER, M., and WILLENEGGER, H. (1965), Technique o f hlternal Fixation o f Fractures. Berlin: Springer. RAHN, B. A. (1970), personal communication.
Requests for reprints shouMbe addressed to:--N. St. J. P. Dwyer, Esq., M.B., Ch.B.(Edin.), F.R.C.S.(Eng. and Edin.), Royal Orthopaedic Hospital, Northfield, Birmingham 3 I.
ABSTRACTS VASCULAR INJURIES
Vascular Injuries Eighteen cases of vascular injuries are described in detail, all of whom were men aged between 5 and 66 years. Six injuries were sustained in road accidents, 5 in the course of work, 6 were due to other forms of accident, and 1 due to an assault. The worst cases were those occurring in road accidents or at work where the whole limb was badly crushed with damage to skin, vessels, nerves, and bones. There were 8 cases where arterial injuries were uncomplicated and these comprised 1 case of direct contusion, 4 lacerated wounds, 1 stab wound, and 2 due to gunshot wounds. The other cases had associated injuries, in 3 of which there was compression of the artery by fracture; in 2 there were haematomata and in 2 the artery was divided by the fracture. In 4 others the artery was contused and all of these were complicated by thrombosis. There were 10 cases where the vascular injury was not complicated by any division of the vessel itself, 13 were closed injuries and 5 open. The arteries involved were 5 femoral, 5 popliteal, 4 brachial, 1 tibial, 1 radial, and 1 internal carotid. Results: Thirteen of the 18 cases had a complete restoration of anatomical and functional normality. One had a good anatomical recovery with some loss of function. One was followed by partial anatomical and functional disability and there were 3 total failures. The authors conclude that arteriography is important in diagnosing the exact nature and the site of the lesion. They advocate prompt surgical treatment of the majority of cases and do not feel that drug therapy using antispasmodics or anticoagulants has much place. RICCIARDI,L., and PETRASSI,A. (1969), ' Vascular Injuries ', Clinica ortop., 21, 203.
Arterial Injury Thirty arterial injuries over 10 years included 19 of iatrogenic origin, 6 from road accidents, and 2 sustained at work. Complicating lesions other than the arterial were present in 11 cases. Iatrogenic lesions were usually complications of arteriography. Fourteen cases were treated by primary operation, 5 by secondary operation, and 11 conservatively. There was 1 death and 2 cases of gangrene. MATHXESON, F. R. (1969), ' Acute Arterial Injuries in Civilian Practice ', Acta chir. scand., 135, 15. Arteriovenous Fistula From experience with 4 cases of arteriovenous fistula it appears that changes in the artery proximally become irreversible within a year. Early closure prevents this. LINDENAUER, S. M., THOMPSON, N. W., KRAFT, R. O., and FRY, W. J. (1969), ' Late Complications of Traumatic Arteriovenous Fistulas ', Surgery Gynec. Obstet., 129, 525. Arteriovenous Fistula after Laminectomy Angiography is necessary in confirming the diagnosis of an arteriovenous fistula following laminectomy and in demonstrating the nature and extent of the lesion. Trauma to the vessels is usually caused by a pituitary forceps passing through the anterior longitudinal ligament. Patients may present with cardiac failure in the immediate postoperative period. However, the symptoms and signs of a fistula may develop only after many months or years. Because of the rapid blood-flow through the arteriovenous shunt, the injection of a large bolus of contrast material is necessary. A case of arteriovenous fistula following lumbar disk surgery is presented. DAWES, J. M. C. (1969), ' Ilio-iliac Arteriovenous Fistula following Laminectomy ', Clin. Radiol., 20, 103.