The Role of Arteriography in Assessing Popliteal Artery Injury in Knee Dislocations

Klineberg, Eric O.; Crites, Brian M.; Flinn, William R.; Archibald, J.; Moorman, Claude T.

doi:10.1097/01.ta.0000075346.05460.d6

Cited by 84 publications

(50 citation statements)

References 27 publications

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“…The complete absence of pulses is an uncommon and very late finding in compartment syndrome; whereas absent pulses seen immediately after blunt lower extremity trauma mandate immediate evaluation for vascular injury. Absent pulses are 58 -80% specific for vascular injury in blunt trauma (6,(13)(14)(15)(16)(17). Ultimately, it was thought that the compartment syndrome was a complication resulting from the popliteal artery injury.…”

Section: Discussionmentioning

confidence: 99%

Vascular Injury After Occult Knee Dislocation Presenting as Compartment Syndrome

Steele

Singh

2012

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Vascular Injury After Occult Knee Dislocation Presenting as Compartment Syndrome

Steele

Singh

2012

The Journal of Emergency Medicine

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“…The necessity for routine angiography has been contentious, some authors considering it mandatory 4,14,15 while others believe that it is only necessary in selected cases. 16,17 Overall the published evidence suggests that routine angiography in knee dislocation is not necessary, only being performed if there is doubt about the circulatory status of the limb. Magnetic resonance angiography (MRA) is an alternative to standard angiography.…”

Section: Article In Pressmentioning

confidence: 97%

(iii) The dislocated knee

Robertson

Nutton

2006

Current Orthopaedics

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“…Levy et al [10] reported a shortage of high-quality evidence from which to base diagnosis and treatment decisions, specifically those related to vascular injury. Routine arteriography has been advocated by some [1,13], although there has been a gradual shift in opinion toward more selective use of angiography [6,9,16]. We therefore performed a review of a large trauma database and asked the following questions: (1) What patient factors are predictors of vascular injury after knee dislocation?…”

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 Popliteal Artery Injury in Knee Dislocations

Abstract: No limb with initial normal vascular examination results was found to have a vascular injury that required treatment. Routine screening angiography may not be necessary for all patients with traumatic knee dislocations.

Cited by 84 publications

References 27 publications

Vascular Injury After Occult Knee Dislocation Presenting as Compartment Syndrome

Vascular Injury After Occult Knee Dislocation Presenting as Compartment Syndrome

(iii) The dislocated knee

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

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