Acute Limb Ischemia Following Femoral And Tibial Shaft Fractures: Predictors And Outcomes

Abstract

Background: Acute limb ischemia (ALI) complicating femoral and tibial shaft fractures is a limb-threatening emergency that requires rapid recognition and coordinated orthopaedic–vascular management. Despite being uncommon, delayed diagnosis can result in irreversible muscle necrosis and amputation. This study evaluates the predictors and outcomes of ALI in long-bone fractures of the lower limb.

Aims and Objectives: To identify clinical and radiological predictors of acute limb ischemia in femoral and tibial shaft fractures and to assess limb-salvage outcomes following timely intervention.

Materials and Methods: A prospective observational study was conducted over 24 months, including 144 patients with femoral and tibial shaft fractures. Vascular status was assessed through pulse examination, ankle–brachial index (ABI), Doppler, and CT angiography. Eighteen patients (12.5%) diagnosed with ALI formed the study cohort. Data on injury pattern, vascular lesions, management sequence, and outcomes were analyzed.

Results: Among the 18 patients with ALI, the majority were young males injured in road traffic accidents. Tibial fractures accounted for 55.6% of cases. Thrombosis (38.9%) and intimal tears (27.8%) were the most common arterial lesions. External fixation before revascularization was performed in 55.6% of cases. Limb salvage was achieved in 77.8%, while 22.2% underwent amputation. Predictors of poor outcome included MESS >7, delayed revascularization (>6 hours), severe fracture displacement, open fractures, and complete arterial transection.

Conclusion: ALI in shaft fractures demands early diagnosis and rapid multidisciplinary intervention. Delays in revascularization and severe injury patterns significantly worsen outcomes, highlighting the need for aggressive early vascular assessment in all high-energy long-bone fractures.