Vascular Injury With Fracture or Dislocation is a limb‑threatening sequela that hides behind apparently normal pulses. Recognising hard signs, applying the 0.9 ABI/API gate, and using temporary shunts can save the limb during the critical reperfusion hour. This video breaks down the anatomy, assessment and management steps every clinician needs. ⏱ Chapters 0:00 Intro 0:21 A Tethered Artery Behind Every Dislocation 1:23 Posterior Elbow Dislocation — The Brachial… 1:57 Humeral Head Displaced Into The Axilla… 2:26 Tibial Plateau Fracture With A 4 Cm… 2:51 Recognise: Hard And Soft Signs 3:37 Absent Distal Runoff On Cta — An Actionable… 4:14 The 0.9 Gate 5:40 Vessel, Bone, Or Shunt? 7:25 Patent Popliteal Flow Through A Vein… 8:20 After The Clamp Comes Off 9:48 Deep Posterior Compartment Haematoma — The… 10:32 Recap & sources The video explains how fractures and dislocations can injure tethered arteries such as the popliteal, brachial and axillary vessels, why a normal pulse does not exclude injury, and how to differentiate hard from soft signs. It covers the 0.9 ABI/API screening threshold, the role of temporary shunts in damage‑control perfusion, and the urgency of reperfusion within the golden hour to prevent irreversible muscle loss and compartment syndrome. 🦴 IN THIS VIDEO YOU'LL LEARN • How tethering of the popliteal artery at the adductor hiatus and soleus arch makes it vulnerable in knee dislocation and tibial plateau fracture • Why the brachial artery is at risk in supracondylar fractures and elbow dislocations due to its anterior crossing of the joint • The mechanism of axillary artery injury in shoulder dislocation and proximal humeral fractures, especially in older patients with atherosclerotic vessels • How to identify hard signs of vascular injury (active bleeding, expanding/pulsatile haematoma, bruit, thrill, absent pulse, ischaemic limb) • How to recognise soft signs (history of bleeding, small stable haematoma, pulse asymmetry, neurological deficit, proximity wound) and when to order ABI/API or CTA • The clinical significance of an ABI or API value below 0.9 as a screening gate for further vascular imaging • When and how to apply a temporary intravascular shunt to restore flow while skeletal stabilisation or transfer is arranged • Why reperfusion after the golden hour increases the risk of reperfusion injury, compartment syndrome and the need for early fasciotomy • The importance of documenting neurovascular status before and after reduction, and repeating examinations during postoperative care 📌 KEY TAKEAWAYS ✔️ Hard signs mandate immediate vascular control; do not delay for imaging if the limb is threatened ✔️ A normal pulse is reassuring only when the whole examination, ABI/API and mechanism are reliable ✔️ The 0.9 ABI/API threshold guides screening: values below prompt CTA or duplex in stable patients ✔️ Temporary shunts are damage‑control tools, not definitive repair, buying time for skeletal stabilisation or transfer ✔️ Reperfusion within the first hour is critical to salvage muscle and avoid compartment syndrome ✔️ Serial neurovascular and compartment checks are essential after reduction, fixation and repair 👩⚕️ WHO THIS IS FOR This resource is designed for orthopaedic trainees, medical students, clinicians managing trauma, and interested patients who want to understand vascular injury associated with fractures and dislocations. 📚 RELATED TOPICS: Popliteal artery injury in knee dislocation · Brachial artery assessment after elbow trauma · Axillary artery risk in shoulder dislocation · ABI and ABI interpretation in extremity trauma · Temporary intravascular shunt techniques · Fasciotomy indications after reperfusion 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #vascularinjury #fracturedislocation #hardsigns #ABIscreening #temporaryshunt #reperfusionhour #poplitealartery #brachialartery #axillaryartery #kneedislocation #tibialplateaufracture #elbowdislocation #shoulderdislocation #compartmentsyndrome #fasciotomy