Popliteal artery injury with fractural dislocation of the knee

Alberty, Roger E.; Goodfried, Gary; Boyden, Allen M.

doi:10.1016/s0002-9610(81)80008-6

Cited by 69 publications

(18 citation statements)

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“…2002;137:585-589 B LUNT TRAUMA to the lower extremity has been associated with a 28% to 46% rate of injury to the popliteal artery [1][2][3] in the form of transection, occlusion, or intimal injury. The popliteal artery, by virtue of its ligamentous fixation and anatomic relationships to the femur, tibial plateau, and knee joint apparatus, is uniquely susceptible to injury with blunt extremity trauma.…”

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confidence: 99%

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Abou-Sayed

Berger²

2002

Arch Surg

103

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Abandoning mandatory angiography in patients with blunt lower-extremity trauma and normal neurovascular examination results does not affect limb salvage.Design: Retrospective, nonrandomized cohort study. Mean follow-up (31 of 52 patients) of 9.5 months (range, 0-96 months).Setting: Single-institution, academic level I trauma center.Patients: Medical records of patients presenting emergently with knee dislocation, distal femoral fractures, or proximal tibial fractures during a 20-year period were reviewed. Fifty-three injuries occurred in 52 patients. Patients were predominantly male (81%) and young (mean age, 32.7 years). Mechanisms and side of extremity injury, coincident injuries, and neurovascular status on admission were recorded. Hard signs of arterial insufficiency or compartment syndrome were identified.Interventions: Angiographic findings and operative and nonoperative interventions were recorded to identify whether angiographic data would alter therapy dictated by clinical findings alone.Main Outcome Measures: Limb salvage rate and necessity for vascular surgical intervention based on an-giographic data in patients with normal neurovascular examination results.Results: Multiorgan trauma occurred in 11 patients. Pulses were normal in 35, absent in 16, and diminished or identified by Doppler signal in 2. Arterial insufficiency or compartment syndrome was present in 29%. Twenty-seven patients (28 limbs) underwent angiography at the discretion of the attending surgeon. Of 13 abnormal arteriograms, 2 occurred in patients with normal pulses and 11 in patients with abnormal examination results. Thirteen of 36 patients with normal pulses underwent angiography; none had clinically significant arterial injuries that necessitated intervention. No vascular interventions were necessary in 23 patients with normal pulses who did not undergo angiography (PϽ.001). Normal neurovascular status bore a 100% negative predictive value in determining the necessity of vascular intervention.Conclusions: Angiography is unnecessary in the routine evaluation of the patient with blunt lower-extremity trauma who presents with a normal neurovascular examination result and can be used selectively for patients with diminished pulses who lack associated indications for mandatory operative exploration.

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confidence: 99%

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Abou-Sayed

Berger²

2002

Arch Surg

103

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“…8). Some authors have taken the view that all patients should have an angiogram [32,33,41,[46][47][48][49][50]. Other authors consider that routine angiography is not required and that it is necessary only in cases where there has been evidence of impaired circulation [24,30,[51][52][53][54][55][56].…”

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confidence: 99%

Acute Knee Ligament Injuries and Knee Dislocation

Keating

2014

European Surgical Orthopaedics and Traumatology

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“…Yine, daha önceden bilin teriyel hastalığı olan hastalarda da arteriyografinin uygulan gereksiz cerrahi eksplorasyonu önleyeceği gibi, muhtemel sonrası için popliteal arter distalindeki akımı da görüntüley tir. Yaralanma ile başvurmuş olan hastalarda, zaman kaza açısından, ameliyathanede ve cerrah tarafından direkt femo tere kontrast maddenin verilmesi ile yapılan arteriyografinin ve yeterli olduğuna dair yayınlar mevcuttur [16][17][18]. Gecikmiş vakalarda (12-24 saat) preoperatif olarak arteriy yapılması gerekir.…”

Section: Tedaviunclassified

“…Popliteal arteriyel yaralanmaları genellikle eşlik eden kas, kemik ve nöral yapıların da hasarı ile birliktelik gösterdiğinden dolayı ortopedi, plastik cerrahi, beyin cerrahisi ve kardiyovasküler cerrahlardan oluşan multidisipliner bir yaklaşım gerekir. Her ne kadar distal perfüzyonun ve kanama kontrolünün sağlanması bu tür yaralanmalarda birinci öncelik ise de, kemik dokuların hasarlı olduğu ve manüplasyonun diğer damarlara hasar vereceğinin düşünüldüğü durumlarda ortopedik cerrahi müdahale ilk önce yapılabilir [18].…”

Section: Tedaviunclassified

Popliteal Artery Injuries

Şahin¹

2011

Ann Clin Anal Med

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ÖzetPopliteal arter yaralanmaları yüksek morbidite ve amputasyon oranlarına neden olmaktadır. Bu yaralanma tipinde hastalarda ilave patolojilerin bulunması, eşlik eden kemik patolojileri, hastaların hastaneye geç olarak ulaştırılmaları hastalarda mortaliteyi önemli oranda arttırmaktadır. Müdahalenin mümkün olduğunca erken yapılması, hipovolemik şokun önlenmesi, sistemik antikoagulasyon uygulanması ve endikasyonu durumunda fasiyotomi yapılması mortalite ve morbiditede düşmeye neden olur. Arter ve ven yaralanmasının birlikte olduğu durumlarda ven ligasyonundan mümkün olduğunca kaçınılmalı, venöz ligasyon yapılmış olan vakalarda kompartman sendromu oluşma riskini ön-lemek amacıyla fasiyotomi yapılmalıdır. Anahtar KelimelerPopliteal Arter Yaralanması, Amputasyon, Fasiyotomi, Hipovolemik Şok.Popliteal artery injuries are an important cause of amputation and morbidity. Existence of concomittant bone or other different pathologies and prolonged time of transport to the hospital leads to increased mortality. On the other hand, early surgical intervention, prevention of hypovolemic shock, systemic anticoagulation and fasciotomy in proper cases decrease morbidity and mortality. In both artery and vein injuries, vein ligation must be a non desirable choice, and when it is inevitable fasciotomy must be performed to prevent development of compartment syndrome.

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Popliteal artery injury with fractural dislocation of the knee

Cited by 69 publications

References 9 publications

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Acute Knee Ligament Injuries and Knee Dislocation

Popliteal Artery Injuries

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