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Taken from Gerry Ahern͛s 3-D model

The most important complication of limb injuries involve the neurovascular bundle, with the
vascular component requiring more immediate attention. All significant limb injuries first require
assessment of peripheral pulses. Most complications occur where the neurovascular structures pass
close to dislocatable joints and commonly fractured bones

Upper Limb

SC joint dislocation Occurs with high-energy impact and puts superior mediastinal
structures at risk such as brachiocephalic veins and aortic arch
branches

Fractured clavicle Normally causes few complications, but significant displacement may
affect the underlying subclavian artery and brachial plexus divisions

Shoulder dislocation Injures the axillary nerve and the posterior circumflex humeral vessels
as they pass underneath the capsule. However, an injury so significant
has the capacity to affect the large nearby neurovascular structures (ie
brachial plexus and axillary artery

Fractured surgical neck of Injures the axillary nerve and posterior circumflex humeral vessels as
humerus they wind around the neck

Humeral shaft Fracture Injures the radial nerve and profunda brachii vessels as they wind
around the shaft

Humeral supracondylar Results from a fall on the hand with elbow flexed, displacing the distal
fracture fragment posteriorly, potentially injuring the ulnar nerve. The main
problem however is the sharp end of the proximal fragment that may
lacerate the median nerve and/or brachial artery. Swelling is
significant and may cause much of the neurovascular problem.
(brachial artery is pinched anteriorly in ͚cleft͛)

Radial neck fracture May injure, compress or stretch the posterior interosseus nerve to the
forearm extensor muscles

Elbow dislocation Usually a posterior displacement that stretches the ulnar nerve as it
passes around the medial epicondyle. Medial epicondyle fracture also
lacerates or stretches the nerve.

Colles fracture Surprisingly, rarely results in significant neurovascular injury.

However, the possibility remains for radial or ulnar artery damage, or
ulnar and/or median nerve damage with marked displacement.
Lower Limb

Fractured neck of femur Displacement of a fracture above the capsule attachment at the neck
will tear the retinacular vessel supply to the head (which are mainly
from the medial circumflex artery)

Retinacular arteries The arteries supplying the femoral head mainly come from capsular
vessels reflected back along the neck. Thus a fracture above the
capsular attachment will likely cause avascular necrosis of the head
(requiring a prosthesis) whereas a fracture below the capsular
attachment (leaving the vessels attached) will simply require a
dynamic hip screw

Dislocated hip Posterior displacement will compress the sciatic nerve. Acetabular
fragments may also lacerate the nerve

Fractured shaft of femur Will tear the local perforating arteries and their large muscular
branches causing large (potentially life-threatening) haemorrhage.
The profunda femoris artery may also be torn

Supracondylar femoral The attachment of gastrocnemius flex the distal fragment with
fracture potential laceration of the femoropopliteal artery. The tibial and
common peroneal nerves are sometimes at risk

Dislocated knee The tibia is usually displaced posteriorly on the femur with (limb
threatening) popliteal artery compression. The tibial and common
peroneal nerves will be affected

Fibular neck fracture The common peroneal nerve will be affected either by direct trauma
or subsequent stretching and swelling

Tibial shaft fracture Will usually not directly affect the tibial vessels unless significant
displacement or swelling occurs. However, the poor blood supply to
the skin over the subcutaneous tibial surface puts its viability at risk

Dislocated ankle Usually results from a bimalleolar fracture and significantly affect both
posterior tibial and dorsalis pedis vessels