Arterial injury in tibial fracture correlates with trauma severity and orthopaedic outcomes

Abstract

Introduction

Tibia fractures are a common fracture of the lower extremity that pose increased risk for vascular injury. The clinical relevance of vascular injury, including particular vessel and number of vessels injured, remains ambiguous. In this study, we evaluate the effect of arterial injury on orthopaedic outcomes for patients with tibia fractures, while identifying trends in fracture characteristics, fixation, and plastic surgery intervention.

Methods

This single-center retrospective cohort study performed at an academic level I trauma center included 61 patients with 62 tibia fractures undergoing computed tomography angiography (CTA) from 2010 to 2019. Patients were stratified by presence (n = 26) and absence of arterial injury (n = 36) with an average age of 43.6 years (74.2% male) and no differences in patient demographics or comorbidities. Primary outcome measures included delayed- or non-union, amputation, compartment syndrome, infection, revision fixation, and time to full weight bearing (FWB). Fracture characteristics, fixation methods, and plastics interventions were also recorded.

Results

Patients with arterial injury had higher rates of open fracture (73.1% vs 44.4%, p = 0.025), infection (46.2% vs 25%, p = 0.042), and delayed- or non-union (42.3% vs 13.9%, p = 0.012). No differences were identified for revision fixation (p = 0.233), compartment syndrome (p = 0.196), amputation (p = 0.093), time to FWB (143.4 vs 109.4 days, p = 0.911) or plastic surgery intervention (p = 0.05).

Conclusions

Arterial injury in patients with tibia fractures is associated with higher rates of open fractures and increased risk of infection and delayed- or non-union. Higher-powered studies are required to better characterize the association between arterial injury in tibial fracture and clinical outcomes.