High-Energy Fractures: Neurovascular and Soft Tissue Injuries

Purpose or Learning Objective:

• To emphasize why is important to report neurovascular and soft tissue injuries in high-energy fractures beyond fracture lines.

• To review neurovascular injuries associated with high-energy fractures such as arterial dissection, arterial amputation, brachial plexus injury, or sciatic nerve injury.

• To review soft tissue injuries associated with fractures such as muscle and tendinous injuries, tendon entrapment, and subcutaneous tissue injuries (open and closed degloving lesions).

• To make a brief comment on how to report neurovascular and soft tissue lesions in mangled/threatened extremities.

Methods or Background: Polytrauma is a leading cause of death and disability in young patients. It has been described that near 60% of high-energy polytrauma patients present musculoskeletal injuries. Complex fractures benefit from early and accurate management, and the radiologist should report bone fractures as well as neurovascular and soft tissue injuries adequately. Different neurovascular and soft tissue injury are described throughout our pictorial review, and peculiarities of mangled/threatened limbs are discussed.

Results or Findings:

– Bones: Polytrauma often present complex fractures: long bones, intra-articular, displaced, open, or multifragmentary.

– Neurovascular: Direct and indirect vascular injuries may occur in these patients. Indirect lesions are more frequent in axillary and popliteal arteries. A hematoma surrounding the axillary artery represents an indirect sign of brachial plexus injury. The sciatic nerve is nicely seen in computed tomography images and may be damaged in femoral fractures.

– Soft tissues: Muscle and tendon injuries secondary to sharp bone fragments. Tendon entrapment in wrist and ankle fractures. Soft tissue open and closed degloving injuries, with a high risk of skin necrosis.

– Mangled/Threatened limbs: Whether to amputate or attempt limb salvage is a very difficult decision. Radiology offers crucial information to help determine the best option.

Conclusion: High-energy polytrauma patients often present with musculoskeletal injuries that may hinder recovery and determine future disabilities. Some of these injuries benefit from early and accurate management, and radiologists should adequately report not only fracture lines but also neurovascular bundle and soft tissue injuries.

Publikationsverlauf

Artikel online veröffentlicht:
02. Juni 2025