Early Management
- Vascular Referral
- Follow ATLS protocol.
- Direct pressure over open wound.
- Avoid clamping if possible.
- Relocate, realign and splint the limb.
- Neuro-vascular examination
- Many pulses will reappear after realignment.
Key Signs
- Expanding hematoma may indicate worsening injury.
- Absent Pulses
- Altered sensation
Revascularisation injury
A delay of more than 3-4 hours will lead to warm ischemia, irreversible tissue damage and increase the risk of amputation. Delayed vascularisation also lead to myoglobulinuria and death.
Duplex, CT angeogram need not be done.
Approach
Temporary shunt –> assess vascularity –> skeletal stabilisation –> definitive procedure –> nerve repair if any –>Fasciotomy