Reassessing the Role of Arteriograms in the Management of Posterior Knee Dislocations

Dennis, James W.; Jagger, Ciaire; Butcher, J. Laurence; Menawat, Sunil S.; Neel, Michael D.; Frykberg, Eric R.

doi:10.1097/00005373-199311000-00007

Cited by 93 publications

(40 citation statements)

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“…The authors concluded that all patients with abnormal pulses should undergo angiography or prompt exploration, whereas those with normal pulses could be safely observed with serial examinations for 24 to 48 hours. This stance was similarly supported by data from Dennis et al 12 In their series, 17 of 36 injured limbs without hard signs of arterial insufficiency were studied with angiograms, whereas the remainder were observed. In the angiography cohort, all patients had either normal studies or minimal, nonoperative injuries.…”

Section: Commentsupporting

confidence: 57%

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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Section: Commentsupporting

confidence: 57%

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Abou-Sayed

Berger²

2002

Arch Surg

103

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“…In 6 series with 80 popliteal artery injuries in 234 knee dislocations, palpable pulses were present in 32% of popliteal artery injuries (Table 5). 14,17,23,24,32,33 The numerous collateral vessels that provide circulation around the knee are abundant but small in caliber. Frequently, the collateral vessels are also injured secondary to the knee dislocation and are at risk for delayed thrombosis with resultant critical ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Of these six studies, three studies had patients with normal pulses that eventually required surgery, 23,24,33 whereas three studies had no surgical requirement for patients with normal pulses. 14,17,32 Recently, serial physical examination, ABI, and color flow duplex scan have been evaluated for their ability to detect vascular injuries. Serial physical examination is performed for 72 hours on an inpatient basis for the patient who presents with normal neurovascular examination findings.…”

Section: Discussionmentioning

confidence: 99%

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Management of Arterial and Venous Injuries in the Dislocated Knee

Armstrong

Franklin

2001

Sports Medicine and Arthroscopy Review

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Vascular injury is present in 30% of dislocated knees and continues to account for significant morbidity. Popliteal artery injury results in a disproportionate number of amputations compared with other extremity arterial injuries. The vascular anatomy and mechanism of injury are reviewed here. A high index of suspicion and systematic evaluation for vascular injury associated with knee dislocation are required to ensure correct diagnosis. Early recognition of vascular injury, prompt restoration of flow, and use of proven adjuncts provides the optimal possibility of limb salvage of popliteal artery injuries associated with knee dislocations.

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“…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]. Hollis and Daly [57] reported on 39 knee dislocations where routine angiography had been carried out.…”

Section: In Higher Energymentioning

confidence: 99%

Acute Knee Ligament Injuries and Knee Dislocation

Keating

2014

European Surgical Orthopaedics and Traumatology

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Reassessing the Role of Arteriograms in the Management of Posterior Knee Dislocations

Cited by 93 publications

References 0 publications

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Blunt Lower-Extremity Trauma and Popliteal Artery Injuries

Management of Arterial and Venous Injuries in the Dislocated Knee

Acute Knee Ligament Injuries and Knee Dislocation

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