Title : One-stage hybrid surgery for limb closed fracture concomitant with major vascular injury
Abstract:
Objective: The standardized management of limb closed fracture concomitant with major vascular injury has long presented a significant clinical challenge. Traditional approaches generally entail sequential fracture reduction and fixation, followed by open vascular repair. Unfortunately, patients frequently experience prolonged delays due to the preparation required for fracture reduction, fixation, and anesthesia, which can result in missing the critical window for vascular recanalization. To address this issue, we have introduced a hybrid surgery that integrates one-stage endovascular strategy with internal fracture fixation, achieving clinically significant and favorable outcomes.
Methods: A retrospective comparative analysis of 24 patients with limb closed fractures concomitant with major vascular injuries admitted to our medical center from July 2018 to June 2024 was conducted. Among these patients, 9 cases were treated with one-stage DSA-guided endovascular covered stent implantation combined with internal or external fracture fixation (hybrid group). The remaining 15 patients were treated with fracture reduction, internal or external fixation, and vascular repair or grafting using autologous saphenous vein (traditional group). Interval time from emergency room admission to vascular recanalization, operation time, intraoperative blood loss, limb salvage success rate, Fugl-Meyer scores were compared between the two groups. Additionally, complications such as re-occlusion, rebleeding, and infection were evaluated.
Results: There were no significant differences in age, gender, and preoperative ischemic time between the two groups. The interval from emergency to vascular recanalization was 73.2±16.4 minutes in the hybrid group compared to 101.6±27.8 minutes in the traditional group (p < 0.001). The operation time was 68.9±27.2 minutes in the hybrid group versus 95.1±33.0 minutes in the traditionalgroup (p < 0.001). Intraoperative blood loss was 53.2±13.5 mL in the hybrid group compared to 160.8±57.9 mL in the traditional group (p < 0.001). The limb salvage success rate was 100% in both groups. However, the Fugl-Meyer score was significantly higher in the hybrid group (94.6±3.8) than in the traditional group (85.4±9.0) (p=0.018). Additionally, the incidence of complications was lower in the hybrid group (11.1%) compared to the traditional group (20.0%) (p = 0.020).
Conclusions: One-stage hybrid surgery combining vascular and orthopedic interventions is appropriate for the management of closed fractures with associated major vascular injuries. This approach offers several advantages, including minimal surgical trauma, reduced vascular recanalization time, enhanced safety, and superior functional recovery.
Key words: closed limb fracture, closed limb vascular injury, endovascular surgery, internal fixation
