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Nerve Injury 71% with arterial injury have nerve injury 39% of patients without nerve injury and vascular repair will have normal extremity 7% of patients with nerve injury and arterial repair will have normal extremity Visser, AM J Surg, 1980 Brachial Plexus Most show signs of recovery 2-4 weeks Surgical indications no improvement at 3 months Recovery potential not related to severity of injury The appearance of recovery at 4 weeks Vrettos, J Hand Surg, 1995 Fractures Fractures may have significant comminution These fracture heal quickly if closed reduction performed with or without internal or external fixation Comminution acts almost like a bone graft to enhance healing, provided soft-tissue damage is not excessive Because of comminution fractures are usually very unstable Difficult to maintain length with closed methods Fractures Fracture lines usually propagate beyond what can be seen on traditional radiographs Out of plane of radiograph Non displaced cracks Be prepard to extending fixation beyond what traditionally would be done for fracture i.e.. Subtrochanteric fracture with lesser trochanter intact, use nail with neck fixation as opposed to standard nail. Cases 23 y.o. male Single low-energy GSW to leg ABI 1.0 Neurologically intact XR: Fracture of distal femur Moderate comminution noted Lateral condyle comminuted through articular surface Not fully appreciated on plain film Note fixation of lateral condyle for unappreciated comminution 27 y.o. male GSW to right leg ABI = .7 On table angiogram Laceration of popliteal artery Temporizing external fixator placed to stabilize length of limb Arterial repair performed Note comminution of fractured femur Almost Complete Healing by 3, 5 Months 19 y.o. male GSW to leg ABI = .95 Neuro intacy Radiographs Comminuted fracture femoral shaft 2 months post op Early healing with callus forming Weight Bearing as tolerated, No pain 28 y.o. male Shotgun load with large pellets Neuro intact Vascular intact Large lateral wo
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