Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Neurovascular compromise after fracture or reduction
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
A dysvascular or newly weak limb is an emergency
Fracture, dislocation, swelling, casts and operative implants can occlude, tear, entrap or compress vessels and nerves; irreversible muscle and nerve injury begins before late skin colour or pulse changes are complete.
Action: Control bleeding without blind clamping, document exact arterial and nerve findings and time, urgently realign and splint a pulseless deformity, repeat examination, release constrictive material, and obtain immediate consultant orthopaedic plus vascular or plastic input for persistent dysvascularity or a new deficit that does not resolve with simple pressure-relieving measures.
Synopsis
Document named arterial and peripheral-nerve function before and after every limb intervention, restore alignment immediately when deformity compromises perfusion, distinguish arterial, compartment and nerve emergencies, and secure time-critical revascularisation or nerve-pathway advice.
Record what each named nerve and artery does, not the phrase neurovascularly intact: test individual motor actions, autonomous sensory areas, pulse quality, Doppler, temperature and capillary refill.
Examine at first opportunity and again after analgesic injection, manipulation, reduction, splintage, casting, before and after surgery and whenever pain, swelling or function changes.
Control haemorrhage immediately with direct pressure, wound packing or the most distal effective tourniquet; do not use blind clamping inside the wound.
Key red flags
Active haemorrhage, expanding pulsatile haematoma, bruit or thrill, a cold pale pulseless limb or rapidly progressive neurological loss requires immediate operative haemorrhage control or revascularisation rather than delayed diagnostic observation.
Investigation priorities
01
First-line timed clinical examinationFirst stepFirst line
Establish arterial and named-nerve status before and after every intervention.
Management branches
DysvascularRealign and restore flow
A fractured or dislocated limb is pulseless, cold, poorly perfused or actively bleeding.
Resuscitate and control haemorrhage with pressure, packing or a distal tourniquet while documenting timed arterial and nerve findings.
Urgently realign and splint the deformity, repeat comparison and activate consultant orthopaedic and vascular or plastic care.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.