Objectives: 

To investigate if any injury to the three primary branches of the popliteal artery in open tibia fractures lead to increased soft-tissue complications, particularly in the area of the affected angiosome.

Design: 

Retrospective cohort comparative study

Setting: 

Two academic level one trauma centers

Patients/Participants: 

Sixty-eight adult patients with open tibia fractures with a minimum one-year follow up;

Intervention: 

N/A

Main Outcome Measurements: 

Soft-tissue outcomes as measured by wound healing (delayed healing, dehiscence, or skin breakdown) and fracture related infection (FRI) at time of final follow-up.

Results: 

Eleven (15.1%) tibia fractures had confirmed arterial injuries via CTA (7), direct intraoperative visualization (3), intraoperative angiogram (3). Ten (91.0%) were treated with ligation and 1 (9.1%) was directly repaired by vascular surgery. Ultimately, 6 (54.5%) achieved radiographic union and 4 (36.4%) required amputation performed at a mean of 2.62 ± 2.04 months, with one patient going on to nonunion diagnosed at 10 months. Patients with arterial injury had significantly higher rates of wound healing complications, FRI, nonunion, amputation rates, return to the OR, and increased time to coverage or closure. After multivariate regression, arterial injury was associated with higher odds of wound complications, FRI, and nonunion. Ten (90.9%) patients with arterial injury had open wounds in the region of the compromised angiosome, with 7 (70%) experiencing wound complications, 6 (60%) FRIs, and 3 (30%) undergoing amputation.

Conclusions: 

Arterial injuries in open tibia fractures with or without repair, have significantly higher rates of wound healing complications, FRI, delayed time to final closure, and need for amputation. Arterial injuries appear to effect wound healing in the affected angiosome.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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动脉损伤预示着更糟糕的软组织结果和开放性胫骨骨折的延迟覆盖

目标： 

调查开放性胫骨骨折中腘动脉三个主要分支的任何损伤是否会导致软组织并发症增加，特别是在受影响的血管小体区域。

设计： 

回顾性队列比较研究

环境： 

两个学术一级创伤中心

患者/参与者： 

68 名开放性胫骨骨折成年患者至少进行了一年的随访；

干涉： 

不适用

主要结果测量： 

最终随访时通过伤口愈合（延迟愈合、裂开或皮肤破裂）和骨折相关感染 (FRI) 衡量的软组织结果。

结果： 

11 例 (15.1%) 胫骨骨折通过 CTA (7)、术中直接可视化 (3)、术中血管造影 (3) 证实了动脉损伤。10 例（91.0%）接受结扎治疗，1 例（9.1%）通过血管手术直接修复。最终，6 名 (54.5%) 实现了放射学愈合，4 名 (36.4%) 需要在平均 2.62 ± 2.04 个月时进行截肢，其中一名患者在 10 个月时被诊断为骨不连。动脉损伤患者的伤口愈合并发症、FRI、骨不连、截肢率、返回 OR 率以及覆盖或闭合时间增加的发生率明显更高。多变量回归后，动脉损伤与较高的伤口并发症、FRI 和骨不连几率相关。十名 (90.9%) 动脉损伤患者在受损的血管小体区域有开放性伤口，

结论： 

开放性胫骨骨折的动脉损伤有或没有修复，伤口愈合并发症、FRI、最终闭合时间延迟和需要截肢的发生率明显更高。动脉损伤似乎影响受影响血管小体的伤口愈合。

证据等级： 

预后等级 IV。有关证据等级的完整描述，请参阅作者须知。