List Archives

Fri, 29 Nov 2002 22:17:30 EST

--part1_170.17ce4214.2b1987ca_boundary
Content-Type: text/plain; charset="US-ASCII"
Content-Transfer-Encoding: 7bit

In a message dated 11/29/2002 7:23:56 PM Eastern Standard Time, 
emdocmjk@bellatlantic.net writes:

> Subj: Posterior knee dislocation 
>  Date: 11/29/2002 7:23:56 PM Eastern Standard Time
>  From: <A HREF="mailto:emdocmjk@bellatlantic.net">emdocmjk@bellatlantic.net</A>
>  Reply-to: <A HREF="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A>
>  To: <A HREF="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A>, <A HREF="mailto:EMED-L@ITSSRV1.UCSF.EDU">EMED-L@ITSSRV1.UCSF.EDU</A>
>  Sent from the Internet 
> 
> 
> 
> Sorry for the cross post, but I wanted to see if there are distinctly
> differing opinions on the following scenario.
> 
> 31 y.o. obese female with left posterior knee dislocation, associated
> open wound in popliteal fossa and probable right knee dislocation which
> was reduced during patient transfer.  Patient has obvious ligamentous
> laxity in right knee.  Other injuries:  left humerus fracture, medial
> orbital wall fracture.  Cause of injury:  pedestrian vs. car.  For this
> discussion, the patient is stable and mentating well and is tentatively
> cleared of all other injuries by XR, FAST and CT scan (H/A/P/T).  PT/DP
> and popliteal pulses are 2+ and ABIs are 1.0.  Sensation is also intact.
> The question:  Angiography or just monitor pulses and ABIs?  There has
> been the reflex that we should always go to angiography in these cases,
> but the orthopedic resident on-call said that we could just monitor the
> pulses and ABIs.  We ended up going to angiography.  Any comments?  
> 
> Michael Klevens, MD
> Temple University Hospital
> Philadelphia, PA
> Emergency Medicine R3
> 

Questions:
1.will you explore and repair intimal tears?
2. Will you treat intimal tears with antiplatelet therapy
3. will the patient undergo CT scan with contrast for some other reason?
4. Do you have a mdct, do you have ready availability of angiography?

If you will explore all minor popliteal injuries, then I would do an 
arteriogram
If you would treat by anticoagulation or antiplatelet therapy intimal 
injuries, then I would do an arteriogram
If the patient will undergo Contrast CT for another reason I would look at 
the popliteal arteries with a CT angiogram if a mdct is available 

Otherwise in an asymptomatic patient I would watch

--part1_170.17ce4214.2b1987ca_boundary
Content-Type: text/html; charset="US-ASCII"
Content-Transfer-Encoding: 7bit

<HTML>In a message dated 11/29/2002 7:23:56 PM Eastern Standard Time, emdocmjk@bellatlantic.net writes: 
 
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">Subj: Posterior knee dislocation 
 Date: 11/29/2002 7:23:56 PM Eastern Standard Time 
 From: <A HREF="mailto:emdocmjk@bellatlantic.net">emdocmjk@bellatlantic.net</A> 
 Reply-to: <A HREF="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> 
 To: <A HREF="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A>, <A HREF="mailto:EMED-L@ITSSRV1.UCSF.EDU">EMED-L@ITSSRV1.UCSF.EDU</A> 
 Sent from the Internet 
 
 
 
Sorry for the cross post, but I wanted to see if there are distinctly 
differing opinions on the following scenario. 
 
31 y.o. obese female with left posterior knee dislocation, associated 
open wound in popliteal fossa and probable right knee dislocation which 
was reduced during patient transfer.&nbsp; Patient has obvious ligamentous 
laxity in right knee.&nbsp; Other injuries:&nbsp; left humerus fracture, medial 
orbital wall fracture.&nbsp; Cause of injury:&nbsp; pedestrian vs. car.&nbsp; For this 
discussion, the patient is stable and mentating well and is tentatively 
cleared of all other injuries by XR, FAST and CT scan (H/A/P/T).&nbsp; PT/DP 
and popliteal pulses are 2+ and ABIs are 1.0.&nbsp; Sensation is also intact. 
The question:&nbsp; Angiography or just monitor pulses and ABIs?&nbsp; There has 
been the reflex that we should always go to angiography in these cases, 
but the orthopedic resident on-call said that we could just monitor the 
pulses and ABIs.&nbsp; We ended up going to angiography.&nbsp; Any comments?&nbsp; 
 
Michael Klevens, MD 
Temple University Hospital 
Philadelphia, PA 
Emergency Medicine R3 
</BLOCKQUOTE> 
 
Questions: 
1.will you explore and repair intimal tears? 
2. Will you treat intimal tears with antiplatelet therapy 
3. will the patient undergo CT scan with contrast for some other reason? 
4. Do you have a mdct, do you have ready availability of angiography? 
 
If you will explore all minor popliteal injuries, then I would do an arteriogram 
If you would treat by anticoagulation or antiplatelet therapy intimal injuries, then I would do an arteriogram 
If the patient will undergo Contrast CT for another reason I would look at the popliteal arteries with a CT angiogram if a mdct is available 
 
Otherwise in an asymptomatic patient I would watch</HTML>

--part1_170.17ce4214.2b1987ca_boundary--

List Archives

For your convenience, find the Trauma List Archive Below

Posterior knee dislocation