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VASCULAR TRAUMA
TRAUMA IMAGEBANK
CASE PRESENTATIONS

 

 

CLASSIC CASES

Popliteal artery transection following blunt knee injury

Case Presentation
A 40 year old male suffers a fracture-dislocation of the right knee following a fall. He is haemodynamically stable and the knee has spontaneously reduced by the time he arrives iin the emregency department. However he has a cold right lower leg with no pulses palpable in the right foot.

X-ray shows a relocated knee but with posterior fragments in the region of the popliteal canal. Abnormal fat densities can be seen in relation to the joint. The patient was transferred directly to the operating room for exploration of the right popliteal artery. The vessel was exposed above and below the knee to gain proximal and distal control, prior to exploring the vessel at the region of the joint space. There was a large haematoma and a completely transected popliteal artery was identified just above the level of the knee joint.

The vessel ends were debrided and mobilised, allowing end-to-end anastomosis without tension.

  

The arterial repair was convered with muscle and the wound closed. Total time from injury to re-establishment of arterial flow was 2 hours 20 minutes, and fasciotomy was not performed. There were good pedal pulses present at the end of the procedure. Post-operatively the knee was stabilised in a cast-brace and the patient mobilised. He was discharged home at 10 days.

Discussion

The diagnosis of vascular injury rests almost entirely on the findings of a careful physical examination. The presence of hard signs of vascular injury mandates immediate operative exploration. The hard signs of vascular injury are a cold, pale and pulseless limb, obvious arterial haemorrhage, expanding haematoma, palpable thrill or an audible bruit. Patients without these signs can be admitted for careful observation and will rarely require intervention.

If the location of injury is known, as with this injury, angiography is not required prior to surgery. Where the location of injury is less clear - with multiple penetrating fragments, high velocity injury or more diffuse blunt trauma, angiography can be performed on the operating room table, after proximal exposure by the operating surgeon.

References

Vascular Trauma - The Basics

Miranda FE, Dennis JW, Veldenz HC, Dovgen PS, Frykberg ER. 'Confirmation of the safety and accurracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study.' J Trauma 2002;52:247-252

Frykberg ER.' Advances in the diagnosis and treatment of extremity vascular trauma.' Surg Clin North Am 1995;75:207-223

trauma.org (7:3) March 2002