The Role of Arteriography in Assessing Vascular Injuries Associated With Dislocations of the Knee

Kendall, Richard; Taylor, David J.; Salvian, Anthony J.; O’Brien, Peter J.

doi:10.1097/00005373-199312000-00013

Cited by 135 publications

(72 citation statements)

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“…In previous studies, the percentage of vascular injuries diagnosed requiring surgical treatment ranged from 64% to 100% [1,5,10,14,[16][17][18]20]. The lower proportion of vascular injury undergoing surgery from our data is interesting since vascular injury secondary to knee dislocation may be severe with a high potential for limb loss [2,7,9,13,15].…”

Section: Discussionmentioning

confidence: 55%

“…Despite the importance in recognition of vascular injuries in patients with knee dislocation, there is much controversy regarding its true frequency, thereby warranting further examination. The reported frequency of vascular injury associated with knee dislocation varies widely, ranging between 5% and 64% [1,5,7,10,14,[16][17][18]20]. In addition, much of the literature is based on very small sample sizes since knee dislocations are uncommon [1,5,10,14,[16][17][18]20].…”

Section: Introductionmentioning

confidence: 99%

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What Is the Frequency of Vascular Injury After Knee Dislocation?

Natsuhara

Yeranosian

Cohen

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting. Questions/purposes Using a large private insurance database, we determined the frequency of vascular injury in knee dislocations across year of diagnosis, age, sex, and US geographic region and the proportion of these injuries requiring surgical repair. MethodsThe PearlDiver database, which contains records from 11 million orthopaedic patients, was searched using ICD-9 diagnostic codes for all knee dislocation events from 2004 to 2009. Within this subset, we identified which knee dislocations had an associated vascular injury ICD-9 code. Patients were stratified by year of diagnosis, age, sex, and US geographic region, and Current Procedural Terminology codes were used to identify the subset of patients with vascular injury requiring surgical repair. Differences in frequency across demographic groups and over time were analyzed with Poisson regression analysis. Results Among the 8050 limbs with knee dislocation identified over the study period, 267 had a concomitant vascular injury for an overall frequency of 3.3%. Males were found to have an increased risk of vascular injury compared to females (odds ratio = 2.59, p \ 0.001). Additionally, patients aged 20 to 39 years had a higher risk of vascular injury when compared to those aged 0 to 19 years (odds ratio = 1.93, p = 0.001), 40 to 59 years (odds ratio = 1.57, p = 0.014), and 60 years or older (odds ratio = 2.81, p = 0.036). There were no differences in vascular injury frequency across US geographic regions or diagnosis year. Thirty-four of the 267 cases of vascular injury (13%) underwent surgical treatment. Conclusions This is the largest study, to our knowledge, that analyzes the proportion of knee dislocations that result in vascular injury. Our data suggest that there is a lower frequency of vascular injury associated with knee

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

What Is the Frequency of Vascular Injury After Knee Dislocation?

Natsuhara

Yeranosian

Cohen

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…All our patients presented with hard signs such as absent pulses and cold extremities and were taken to operating room without any delay. The role of angiographic evaluation is controversial mostly limited to absent hard signs but high-suspicion situation like dislocations of the knee [18]. There is no role for angiography in the presence of hard signs.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Arterial Injuries: an Indian Experience

Joshi

2015

Indian J Surg

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Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1 %) were males and 6 (9.8 %) females aged between 5 and 70 years. The mean duration of presentation was 21 h. Majority were resultant of road traffic accidents (62.7 %). Among 49 (80.3 %) noniatrogenic injuries, the mechanism was blunt in 46 (93.8 %, n=49) and penetrating in 3 (6.1 %) cases. Iatrogenic injuries were seen in 12 (19.6 %) cases. Lower limbs accounted for 37 (60.6 %) cases, popliteal segment being common, 22 (36 %) cases. Bony injuries were associated in 39 (63.9 %) cases. The most common procedure was interposition graft (49.1 %). Six (9.8 %) patients required an amputation resulting in 55 (90.1 %) salvaged limbs.Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India.

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“…Sillanpää et al [21] similarly warned increasing body proportions are leading to a changing paradigm in the epidemiology of knee dislocations and associated vascular injuries. Although historical literature suggested that mechanism of injury and the degree of injury severity (ISS) were useful predictors of vascular injury [7,8,10,14,25], this was not the case in our study or others [3,21]. To our knowledge, our study is one of the only studies that investigates open injury as a risk factor for vascular injury after knee dislocation; however, Wright et al [27] reported a series of 19 patients with open knee dislocations and found that nine (47%) had some form of concomitant vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…A similar concept is used by acute care surgeons during the evaluation of appendicitis, where it has been suggested that a significant false positive rate is necessary to ensure a diagnostic sensitivity of 100% [5]. The absence of pulses alone has been suggested in some studies [7,8,10,11,14,24,25] as being sufficient to detect vascular injury, although each of the studies had limited patient sample size and relied on antiquated technology. Moreover, these studies were limited by their selective use of the ABI, which has been shown to be a valuable adjunct to the vascular examination.…”

Section: Discussionmentioning

confidence: 99%

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. Questions/purposes We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities of palpable dorsalis pedis or posterior tibial pulses, and the presence of an anklebrachial index (ABI) of 0.9 or greater?Methods A database at a Level I trauma center was queried for patients with evidence of knee dislocation, demographic information (age at the time of injury, sex, Injury Severity Score, BMI, mechanism of injury), and the presence of open injury were recorded. One-hundred fortyone patients underwent screening at initial presentation, of whom 26 (24%) underwent early vascular exploration based on an abnormal physical examination. One-hundred five (91%) of the remaining 115 patients were available at a minimum followup of 6 months (mean, 19 ± 10 months). In total, 31 unique patients were excluded, including 10 patients (7%) who were lost to followup before 6 months. Among the 110 patients who met inclusion criteria, the mean age and SD was 37 ± 13 years, and the Injury Severity Score was 15 ± 9. There were 71 males (65%). Logistic regression was used to determine independent correlates of vascular injury. The vascular examination was reviewed for the presence of a palpable pulse in the dorsalis pedis artery, the presence of a palpable pulse in the posterior tibial artery, and whether the ABI in the dorsalis pedis was 0.9 or greater. Contingency tables were generated to assess the sensitivity, specificity, and accuracy of physical examination maneuvers. The physical examination was collectively regarded as ''normal'' when both pulses were palpable and the ABI was 0.9 or greater. The initial physical examination as just described was considered the diagnostic test being evaluated in this study; ''positive'' tests were evaluated by and confirmed at vascular surgery, and 6 months clinical followup without symptoms or progressive signs of vascular injury confirmed the absence of injury in the remainder of the patients. Contingency tables were generated again to assess the sensitivity, specificity, and accuracy of the combined physical examination.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity w...

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The Role of Arteriography in Assessing Vascular Injuries Associated With Dislocations of the Knee

Cited by 135 publications

References 0 publications

What Is the Frequency of Vascular Injury After Knee Dislocation?

What Is the Frequency of Vascular Injury After Knee Dislocation?

Peripheral Arterial Injuries: an Indian Experience

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

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