Dr. Aufranc: This is the second in our current series of tibial-shaft fractures. These fractures have been specifically chosen because of their severity and because of associated soft-tissue and bone injuries. In today's case we will concentrate our discussion on the tibial fracture and the adjacent vascular injury. However, we cannot ignore the fact that patients such as this one may have associated injuries which are more life-threatening than their extremity fracture.
Dr. Richard G. McCollum: A 70-year-old man was struck by an automobile while crossing a street in a northern suburb of Boston. At the time of his arrival at the Massachusetts General Hospital emergency ward, approximately 40 minutes following his injury, he was confused and disoriented. Blood pressure was 110/50 mm Hg, but the patient was cold and clammy, with a tachycardia of 120 beats per minute. He had an obvious fracture of the proximal left tibia and