Algorithm of Monazzam et al for Evaluating a Patient with a Lower Extremity Fracture for Vascular Injury

Description

Monazzam et al developed an algorithm for the evaluation of major arteries in a lower extremity with one or more fractures. This can help to identify a patient who may require CT angiography. The authors are from the University of California Davis and the University of California San Diego.

Patient selection: lower extremity fracture

Hard signs of vascular injury:

(1) absent distal pulses

(2) pulsatile bleeding

(3) cold/pale limb

(4) expanding hematoma

(5) palpable thrill

(6) audible bruit

Soft signs of vascular injury:

(1) decreased pulses compared to contralateral side

(2) any peripheral nerve deficit

(3) small local hemorrhage(s)

(4) wound near an artery

(5) non-pulsatile hematoma

Parameters:

(1) hard vascular sign

(2) soft vascular sign

(3) ankle-brachial index (ABI)

Hard Signs	Soft Signs	ABI	Action
>= 1	NA	NA	surgery
0	>= 1	> 0.90	observe
0	>= 1	<= 0.90	CT angiography
0	0	NA	no further studies

Chances of having a positive CT angiogram:

(1) open fracture

(2) multiple fractures in one lower extremity

(3) isolated fracture in the proximal third of the fibula

(4) fracture in the mid or distal tibia

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Algorithm of Monazzam et al for Evaluating a Patient with a Lower Extremity Fracture for Vascular Injury

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