Nailing before vascular repair in tibial fracture with associated arterial injury.

Abstract

The incidence of arterial injuries in extremity fractures is approximately 1% to 2%. In patients with combined vascular and orthopedic injury but without a mangled extremity, the decision whether to give priority to the fracture fixation or to the vascular repair is still somewhat controversial. We successfully used the unreamed tibial nail before the arterial repair when treating an open tibial shaft fracture associated with a torn anterior tibial artery and present it as an illustrative case for the method. Fracture alignment was achieved manually and an unreamed tibial nail was introduced. The nail was secured only proximally by two interlocking screws inserted through jig. The procedure provided good alignment and length for end-to-end reconstruction of the anterior tibial artery. The distal interlocking screws were inserted at the end of vascular reconstruction.