What Is the Frequency of Vascular Injury After Knee Dislocation?

Abstract

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

Geographic variation in fasciotomy during operative management of tibia fractures

“…A multitude of incidence and demographic studies of orthopedic injury have been used the PearlDiver database since 2010. [6][7][8][9][10][11][12][13][14][15][16][17] PearlDiver provided state totals of operatively managed tibia fractures and state totals of patients who have had both a lower extremity fasciotomy and an operatively managed tibia fracture from 2007 to 2011. State procedure volumes less than eleven were censored by PearlDiver to protect patient privacy.…”

Behandlung der akuten Kniegelenksluxation

“…Bei teilweise nur geringen Studienkollektiven werden vaskuläre Begleitverletzungen bei 3-30 % angegeben [18]. In einer Auswertung von 8050 Kniegelenksluxationen wurde bei 3,3 % der Patienten eine Gefäßbeteiligung beobachtet, wobei lediglich 13 % dieser Gefäß-verletzungen operativ behandelt werden mussten [18].…”

“…Bei teilweise nur geringen Studienkollektiven werden vaskuläre Begleitverletzungen bei 3-30 % angegeben [18]. In einer Auswertung von 8050 Kniegelenksluxationen wurde bei 3,3 % der Patienten eine Gefäßbeteiligung beobachtet, wobei lediglich 13 % dieser Gefäß-verletzungen operativ behandelt werden mussten [18]. Da eine Ischämiezeit >8 h das Risiko für eine Amputation signifikant erhöht und mit einer signifikanten Verschlechterung des Outcomes einhergeht, ist schon bei Verdacht auf Vorliegen einer Knieglenkluxationsverletzung sicherzustellen, dass keine Gefäßbeteili-gung vorliegt [20].…”

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

“…However, advances in technology have offered an expanded array of radiographic tools. This has muddied the clinical algorithms used as a part of various trauma protocols; the exact role of radiography such as CT angiography, arterial duplex, and MR arthrography has been debated, but not settled [6,12,15]. In an increasingly restricted-payer healthcare environment, it would seem prudent to examine the diagnostic utility of advanced radiography and provide an evidence-based analysis of CT angiography.…”