Evaluation of circulatory status is the most important aspect of post reduction care.
Look for hard findings such as cool/cold lower extremity, diminished or absent pulses, pale or dusky skin, paralysis, etc.
However, the absence of these findings should not lull the clinician into a false sense of security. The degree of initial joint deformity, presence of full bounding pulses and warm skin over the dorsum of the foot can all be present in the setting of vascular injury.
The next step will be to perform an ABI (ankle-brachial index).
In one small study, no patient with an ABI greater than or equal to 0.9 had a vascular injury.
Patients with a reassuring physical exam and ABIs should be admitted for vascular checks without further imaging.
Patients with a reassuring physical examination but with an abnormal ABI should have an imaging study obtained (arteriogram/CT angiogram).
Patients with hard findings of a vascular injury should have an emergent vascular surgery consultation.
