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Vascular Injuries Associated w/ Tibial Fractures

- See:
      - Vascular Trauma Associated w/ Fractures   (main dissucssion);
      - Technique of Microanatomosis:

- Discusion:
    - anterior tibial artery occlusion:
          - most common site of vascular injury;
          - occlusion occurs as anterior tibial artery passes from behind thru interosseous membrane;
          - occlusion may cause loss of anterior compartment muscles, even if posterior tibial artery remains patent;
          - compartment syndrome of anterior compartment is common even if diastolic blood pressure is normal;
    - lower leg usually can survive loss of either peroneal artery or posterior tibial artery;
          - it is much less common for posterior tibial artery to be injured w/ frxs of tibia;
          - however, injury to this artery may occur w/ compartment syndromes esp, when an inadequate
                   fasciotomy is performed (one that does not specifically adress the deep compartment;

- Exam:
    - presence of dorsalis pedis pulse does not r/o injury to ATA, since there may be retrograde blood flow from posterior tibial artery;
            - blood is shunted from the posterior tibial artery to the peroneal artery and then to the dorsalis pedis pulse;
    - while pulses are usually present in compartment syndromes, the absence of a pulse (eg. from
            associated fracture or trauma) raises the probability that a compartment syndrome could occur;
            - for instance loss of the anterior tibial artery following a tibial fracture, places the anterior compartment at high risk for compartment syndrome

The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.

The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Limb Reconstruction versus Amputation Decision Making in Massive Lower Extremity Trauma.

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