Assessment and Interventions for Vascular Injuries Associated With Fractures

Clay A. Spitler, MD; David A. Patch, MD; Graeme E. McFarland, MD; Walt R. Smith, MD


J Am Acad Orthop Surg. 2022;30(9):387-394. 

In This Article

Locations and Types of Vascular Injuries

Vascular damage can occur because of direct or indirect trauma. Causes of direct vascular injury include penetrating trauma such as ballistic injuries, puncture wounds, or lacerations. Arterial wall defects, complete transections, and arteriovenous fistulas are generally seen after direct vascular injury. The brachial artery and vein in the upper extremity and the superficial femoral artery and vein in the lower extremity constitute the most commonly injured vascular structures associated with penetrating trauma.[18] Indirect vascular trauma or "blunt force" trauma occurs because of stretching or shear forces that act on a vessel. These types of injuries most commonly result from high-energy mechanisms but may also occur in the morbidly obese population after low-energy injuries. Intimal defects/arterial dissection and subintimal hematomas associated with secondary occlusion are the most common vascular injuries in blunt trauma. Although the data vary between studies, the popliteus artery is generally the most commonly injured vessel in the lower extremity with blunt trauma while the radial and ulnar arteries slightly edge the brachial artery in upper extremity blunt trauma.[19] Another type of vascular injury that merits mentioning is pseudoaneurysm. This vascular anomaly is defined as a pulsatile hematoma communicating with an artery through a disruption in the arterial wall.[20] Pseudoaneurysms represent a rare complication in association with orthopaedic injuries, and data describing the characteristics of this injury after orthopaedic trauma are lacking.[7]