Blunt arterial injuries secondary to bone fractures are frequently associated with nerve, vein and soft tissue lesions. A delayed diagnosis or treatment is the main cause of high amputation rate. Porcellini et al (1977) described 34 patients who presented with acute arterial occlusion (15 cases), false aneurysms (13 cases) or arterio-venous fistulas (6 cases) of the extremity. Various procedures were performed to repair injured arteries associated venous lesions were treated. External fixation of long bone fractures was made in 29 patients before vascular reconstruction to prevent further injury during orthopaedic stabilisation. Fasciotomies were made to treat compartmental compression where necessary. Hyperbaric oxygen therapy was applied in 7 patients to control bacterial contamination and improve wound healing. The authors emphasised that a multidisciplinary diagnostic and management strategy is required to improve limb and patient survival. HBO is an important component of such multidisciplinary strategies. Certain bones have an inherently poor blood supply such as scaphoid which has its blood supply from one end only as does the ankle bone called the talus. The junction between the lower and middle third of the tibia also has a poor blood supply and all three of these types of fracture frequently suffer delayed or non-union. An example of lower/middle third tibial fracture suffered by a patient is as follows: |
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| The patient suffered a severe fractured Tibia & Fibula in a Moto X accident on 16th November 2003 and first came to see us on the 3rd December 2003 with no sign of callus formation (see X-ray right). |  |
| The whole middle segment of the fractured Tibia was displaced out of line making internal fixation with an intra-medullary nail impossible. | |
The double fracture of the tibia severely compromised the blood supply and healing ability of the middle segment. Because of the distinct possibility of necrosis (dying off) of the middle segment it was decided to treat with Hyperbaric Oxygen, Pulsed Laser and Magnetic Field Therapy. At the end of December, following ten sessions of Hyperbaric Oxygen, laser and MFT the patient saw his consultant who removed the plaster and, after expressing surprise that the fracture appeared stable, X-rayed the leg and was further surprised at the remarkable callus formation. Another month later the patient was holidaying in America with no walking aids. Note: The patient suffered a less severe fracture of his other Tibia and Fibula thirteen years ago and it took him seven months to heal!! |
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