How to save your foot and hand after an accident

Dr KK Pandey *

Bone fixation pin used in fixing the fractured bones inadvertently harmed the blood pipe ; Injury to blood pipe of thigh occurred during fixation of bone led to gangrene of foot

During past few years of your life, you must have come across either a friend or a relative or a neighbour who had lost his leg after a road traffic accident. Quite often you might have read in various newspapers that one young man or woman had to lose his or her leg or hand, after sustaining fracture of limb bones in a road traffic accident.

Sometimes, you might have heard about an individual who received multiple physical injuries including fractures after a fall from a height, was taken to a hospital and his life was saved after the treatment, but foot or hand could not be saved as they had become cold and black, and therefore had to be amputated.

In today’s world incidence of physical fights, stabbing and gun fires are very common. In these unpleasant incidences, sometimes you are saved but not your limbs after treatment in hospital.

In today’s fast emerging scenario, more and more people are losing their lives due to grenade and bomb attacks by terrorists. If you are fortunate enough to have survived the attacks, but misfortune might befall on your limbs and may lead to amputation.

Loss of limb is devastating to your mental health

In the prime of your youth, if you happen to lose your leg or hand, you feel very scary and depressed. Although with the help of our modern artificial limb technology, one can control handicaps and inactivity caused due to limb loss, but it is very difficult to handle mental trauma and depression caused by the loss of limb, in your prime youth.

Have you ever thought for a while why people do lose their limbs after various accidents and mishaps? Could the limbs of an injured person after an accident have been saved? Have you already accepted the fact that it is not unusual and surprising to lose leg or hand after sustaining bone fracture in a road traffic accident? If so, it is just because you have heard and seen this happening for the last so many years.

Perhaps, by now in your subconscious mind you have already resigned to the fate that it is a definite and eventual outcome in the form of amputation of hand or leg after an incident of stab or fireman injury in the limb, no matter what you do.

Bone fracture alone never cause a loss of limb

You would never have thought about what actually happens after fracture of leg or thigh bone and what leads to amputation of leg even after a successful fixation of fracture by a plaster or by steel rods. One should understand that fracture of bone alone would rarely lead to loss of leg.

It is very essential to know at this stage that like other organs of body, the legs too needs a constant supply of a pure and oxygenated blood for their proper functioning and survival. If blood supply stops, the hand and foot will became life less, and then reconnecting the fractured bones in a lifeless limb is not only a futile exercise but also a waste of precious money and time.

An injury to blood pipe is not uncommon in case of bone fracture

In majority of the accident cases involving leg or arm bone fracture, the blood pipe is also injured or disrupted simultaneously. This blood pipe that supplies pure blood to the limb is called in medical term an artery. “Total care of the bone fracture-but at the same time little or no care for the coexisting arterial fracture” is the main and single most important cause of loss of leg and arm after accident in India.

You will be surprised to know in our country, 50% cases of vascular injury (arterial) undergo amputation of hand or foot, while on contrary in Europe, only 4% cases have to undergo amputation after vascular (arterial) injury.

This statistics itself explains how serious we are, so far as treatment of vascular injury is concerned. This very fact explains as well as proves the hollowness of so-called big claims made in India about a quantum progress in health care delivery system.

Never waste precious time

If possibility of vascular injury after an accident does exist along with the bone fracture, it becomes all the more essential to repair or reconstruct the damaged artery at the earliest. Delayed repair of artery is equal to a no repair, because if hand and foot do not get pure blood supply for a continuous period of 6 to 9 hours, the muscles of the limbs get damaged permanently.

At this stage, there is no definite advantage of any operation. Bone fracture alone if not fixed or corrected for next 24 hours will not create much problem, but every minute counts after accident, if a bone fracture is also associated with a vascular injury.

Tight plaster too is responsible for loss of fractured limb

The second most common cause of stoppage of blood supply to hand or foot, is the application of an unusually tight plaster after fracture that usually leads to vascular injury. The plaster when abnormally tight constricts the arteries to an extent that the supply of pure blood totally stops.

Incidence of tight plaster-application and subsequent amputation of limb is rampart in India. After plaster-application in a fracture case a careful observation of change in skin colour and temperature is very essential.

Sometimes surgery for bone facture too plays a role in causing loss of limb

The third common cause of vascular injury in accident cases, is the surgery for bone fracture. Sometimes, steel rods, steel pins, used for fixation of fractured bones may damage the adjacent arteries, that leads to disruption in supply of pure oxygenated blood.

This situation results into death of muscles contained in hand and leg. In such a scenario, what is required is the immediate starting of the process of repair or reconstruction of the damaged artery by a vascular or cardiovascular surgeon. If timely intervention is not done, the last and the only hope of salvaging the limbs too goes away.

Use of too tight rubber band during bone surgery may cause loss of limb

Sometimes a special rubber band called ‘tourniquet’ used during surgery of bone fracture is also responsible for damage of artery. This special rubber band (tourniquet) is tied either around thigh or arm to temporarily stop the bleeding during bone surgery, to facilitate the smooth conduct of operation especially bone plating.

Whenever, this rubber band becomes too tight or remains in place for more than the prescribed time limit, the constricted artery gets damaged and leads to collection of blood clots inside the artery. This results into complete stoppage of blood supply to the limbs.

If this situation is confronted, immediately call a vascular surgeon or a cardiovascular surgeon to clear the clots from inside of the artery. If this is not done in time, the possibility of losing hand or foot even after bone plating increases considerably.

What to do if you have sustained bone fracture in an accident?

1. Always go to a hospital where 24-hour availabi- lity of a bone specialist as well as a vascular surgeon or a cardiovascular surgeon is there. Remember bone fracture alone is by and large not a life-threatening emergency, but a delay in treatment of vascular injury may lead to death also.

A person after sustaining a bone fracture in an accident should never waste his precious time in moving from one place to another. Such patient should try to reach directly a modern and big hospital where facility of modern investigations, like Doppler study, Angiography is available to evaluate the blood supply to injured limb. Delay in reaching a proper hospital means delay in repair of a damaged artery.

Delayed restoration of blood supply is not a guarantee for salvage of your hand or foot. These days availability of 64-slice CT-angiography facility in a modern hospital has revolutionized the accident management protocol and thus decision-making has become faster. It helps in salvaging the limb effectively.

If the toes or fingers on the side of fractured limbs are getting cold, immediately request your bone specialist to call a vascular or a cardio vascular surgeon for opinion.

If after plaster application in a bone fracture case, toes or finger start becoming cold or develop tingling sensation, consult immediately a vascular or cardio- vascular surgeon. Go at once to your bone specialist to loosen the plaster or cut it slightly.

After plaster application, the development of coldness and tingling sensation in fingers or toes simply indicates either an injury to the artery has been missed or blood flow in the artery has stopped completely due to outside compression caused by the tight plaster.

If you have undergone an operation for a bone fracture in which steel rods or pins or external fixator has been used, be watchful.

If your family members after operation find that your fingers or toes are becoming cold, less sensitive or blue coloured, immediately request your bone specialist to seek consultation and opinion of a qualified and experienced vascular or a cardiovascular surgeon, instead of a general surgeon. This will help in timely restoration of blood supply and saving your leg or hand from amputation.

If union of fractured ends of bone has occurred after a successful bone fracture treatment, but your fingers or toes are still numb and are associated with either mild pain, or tingling sensation or mild swelling, never miss to consult a vascular or cardiovascular surgeon, so that a concealed vascular injury, may be unmasked and not remain neglected any more.