The following soft signs are much less useful in predicting or excluding major vascular injuries that require intervention. Presence of fracture increases risk. The arterial pressure index is useful in detecting patients with major vascular injury who have pulses that appear normal. Systolic blood pressure in the affected extremity is divided by systolic pressure in the normal extremity. Duplex ultrasonography Ultrasound is an as yet unreliable but very promising noninvasive technique for investigating injuries with a high-risk mechanism or location but without any obvious indication for surgical management.
Ultrasound examination is extremely operator dependent.
This is the criterion standard for evaluation of vascular injuries in trauma. Dye load and renal function are important prestudy considerations. Brachial indices also may be used. Control hemorrhage with direct pressure. Immediately reduce displaced or angulated fractures if any evidence or suspicion of vascular compromise exists.