By Court-Brown, Charles; McQueen, Margaret M.; Tornetta, Paul
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Table 5-1 gives a list of the incidence of vascular injury in different body areas. Injuries to the calf or leg and forearm or antecubital fossa are associated with the highest incidences of vascular injury. There is debate as to how potential vascular injury should be investigated. Patients may present with obvious signs of an avascular limb with absent pulses and the classical signs of ischemia. In these patients urgent surgical exploration is required, although an on-table angiogram may be helpful.
Fasciotomy should be undertaken following revascularization. The success rate of expeditious vascular reconstruction is variable and depends on the location of the vascular injury as well as the extent of the associated muscle and bony injury. NEUROLOGICAL DAMAGE It is reported that the incidence of nerve damage following gunshot injuries varies between 2% and 100%, the difference presumably relating mainly to the type of weapon used. Results from both World War II and the Vietnam War suggest that about 70% of nerve injuries recover spontaneously without surgery, with 90% of them recovering after 3 to 9 months.
They also occur in the fingers and toes, where they are often treated by amputation (see Chapter 37). PREOPERATIVE ASSESSMENT ■ A complete history and physical examination is essen- tial. Some of the main factors that should be obtained in the history are shown in Box 4-1. ■ Age does not affect patient management, but older patients tend to be osteopenic and the fractures may be associated with greater comminution. ■ Information about general health is important because conditions such as diabetes mellitus, metabolic bone ■ ■ ■ ■ 21 diseases, or neuromuscular conditions may alter the type of operative treatment, and cardiovascular, pulmonary, and other medical comorbidities may affect anesthesia and later intensive care.
Trauma by Court-Brown, Charles; McQueen, Margaret M.; Tornetta, Paul