Surgical management and limb salvage outcomes in orthopedic trauma patients with concomitant popliteal artery injury: a single-center retrospective analysis.

Background: Traumatic popliteal artery injury often occurs with complex orthopedic and soft-tissue damage and requires coordinated vascular, skeletal, decompressive, and wound management. We evaluated real-world treatment patterns and limb-salvage outcomes in a single-center cohort of patients with combined orthopedic trauma and popliteal artery injury. Methods: We retrospectively reviewed 48 hospitalization records from 46 patients treated between 2002 and 2025. Repeated hospitalizations related to the same injury were reconciled into 46 independent patient/injury episodes. The primary outcome was limb salvage, defined as avoidance of amputation during the complete injury episode. Primary amputations were described separately, and treatment-associated analyses were restricted to the 42 episodes in which limb salvage was attempted. Vascular, orthopedic, and adjunct procedures were summarized descriptively; selected procedure-associated secondary-amputation rates were compared using Fisher's exact test. Laboratory analyses used variable-specific available cases without imputation. Results: Nine of 46 injury episodes ended in amputation: four were primary amputations and five occurred after attempted salvage. Among the 42 salvage-attempted episodes, 37 limbs were preserved, yielding an observed limb-salvage rate of 88.1%. Formal vascular reconstruction was performed in 27 episodes, including 17 vein graft reconstructions and 10 direct arterial repairs. Limb salvage was observed in 15 of 17 vein graft cases (88.2%) and 9 of 10 direct repairs (90.0%); these rates were considered descriptive rather than comparative. No selected orthopedic or adjunct procedure was significantly associated with secondary amputation. Procedures frequently occurred in combination, particularly vascular exploration with debridement or external fixation, highlighting the integrated nature of limb-salvage care. Admission laboratory comparisons were limited by substantial missingness and showed no significant between-group differences. Conclusions: In this retrospective cohort of traumatic popliteal artery injury, limb salvage was achieved in most patients for whom salvage was attempted. Outcomes after vein graft and direct repair were favorable descriptively, but the small, clinically selected groups do not support comparative efficacy conclusions. Vein graft and direct repair each achieved favorable, though non-comparable, salvage rates, and the frequent overlap of vascular, orthopedic, decompressive, and soft-tissue procedures indicates that limb salvage in this setting is delivered through coordinated, multidisciplinary care rather than any single intervention. These procedure-specific observations remain exploratory and warrant confirmation in larger cohorts with standardized measures of injury severity and ischemia time.