Popliteal artery transection
following blunt knee injury
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.
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
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.
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