What are the consequences of an ankle fracture with a laceration damaging the tibial artery?

From the Guidelines

Seek immediate emergency medical help, as an ankle fracture with a laceration damaging the tibial artery is a life-threatening situation requiring urgent treatment. The consequences of such an injury can be severe, including rapid blood loss, limb loss, and even death if not treated promptly 1.

Initial Response

First, apply firm, direct pressure to the wound using a clean cloth or bandage to control bleeding. Elevate the injured leg above heart level if possible. Do not attempt to reset the fractured ankle. Call emergency services (911 in the US) or activate your emergency beacon if you have one. If cell service is available, call for a helicopter evacuation.

Pre-Hospital Care

While waiting for help:

• Keep the person still to prevent further injury
• Treat for shock by keeping them warm and lying flat
• Monitor breathing and pulse, begin CPR if needed
• Do not give food or drink

Importance of Prompt Medical Intervention

This injury combination is extremely serious. The tibial artery is a major blood vessel, and damage can lead to rapid, severe blood loss. The fracture complicates treatment and increases bleeding risk. Without prompt medical intervention, this could result in limb loss or death from blood loss or complications like compartment syndrome. According to recent guidelines for the acute care of severe limb trauma patients, immediate surgical exploration or rapid radiological examination such as CT angiography or arteriography may be required 1.

Post-Rescue Treatment

Once rescued, treatment will likely involve surgery to repair the artery and stabilize the fracture, as well as blood transfusions and antibiotics to prevent infection. The Ankle-Brachial Index (ABI) may be used to diagnose vascular injury, with an ABI <0.9 having a satisfactory sensitivity and specificity for diagnosing vascular injury 1.

Prevention and Preparation

To prepare for emergencies while hiking, always carry a first aid kit with pressure bandages and a way to call for help. Hike with a buddy when possible and inform others of your planned route and return time. Being prepared and knowing how to respond to such injuries can significantly improve outcomes. Guidelines from the American Association for Vascular Surgery/Society for Vascular Surgery emphasize the importance of prompt treatment for acute limb ischemia, which can result from injuries like this 1.

From the Research

Consequences of Ankle Fracture with Laceration Damaging the Tibial Artery

• The consequences of an ankle fracture with a laceration damaging the tibial artery can be severe and may lead to complications such as impaired blood supply to the affected area 2, 3.
• The tibial artery plays a crucial role in supplying blood to the distal tibia and fibula, and damage to this artery can lead to delayed healing or nonunion of the fracture 3, 4.
• The proximity of the anterior tibial artery to the distal tibia poses a risk of entrapment with a fracture at this level, which can lead to partial nonunion or other complications 4.
• In addition to vascular complications, ankle fractures can also be associated with other injuries such as tendon ruptures, which can further complicate the treatment and recovery process 5.
• The treatment of ankle fractures with associated vascular or tendon injuries requires careful consideration and may involve surgical intervention to repair damaged tissues and restore blood flow to the affected area 2, 3, 4, 5.

Potential Complications

• Impaired blood supply to the affected area
• Delayed healing or nonunion of the fracture
• Partial nonunion or other complications due to entrapment of the anterior tibial artery
• Tendon ruptures or other associated injuries
• Increased risk of posttraumatic arthrosis of the ankle joint if the fracture is not properly treated 6

Importance of Proper Treatment

• Proper treatment of ankle fractures with associated vascular or tendon injuries is crucial to prevent complications and promote healing 6, 2, 3, 4, 5.
• Surgical intervention may be necessary to repair damaged tissues and restore blood flow to the affected area 2, 3, 4, 5.
• Careful consideration of the potential complications and associated injuries is necessary to ensure optimal treatment and recovery outcomes 6, 2, 3, 4, 5.