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Wed Jul 30 23:46:33 BST 2008

I agree. It should be called ultra-low-velocity!

>>> "McSwain, Norman E Jr." <nmcswai at tulane.edu> 31/07/2008 6:44 am >>>
I do  not think I would class a very obese patient as a low energy fall.
Possible low speed but with the weight behind it there is not low
energy. Yes I know that the KE formula is velocity squared and more
important, but the mass is still significant. You will recall that in
the War of Northern Aggression (1861) the .58 cal Springfield long rifle
with the heavy Minie ball has almost the same muzzle energy as the M16
.223.  (1000 Ft. lbs. vs 1200 ft. lbs.) It was the extra mass that gave
it the high energy albeit much slower than the M16 (950 f/s vs 3000 f/s)

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu 
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Zsolt Balogh
Sent: Wednesday, July 30, 2008 1:52 AM
To: trauma-list at trauma.org 
Subject: Re: popliteal angiography for asymptomatic knee dislocations

Dear Sal,

Traditionally knee dislocations are classified as high energy (MVC, high
falls) and low energy (sport-related). Now we have the new group the
ultra-low-energy from morbidly obese patients with minimal trauma,
slipping on stairs or kerb etc. This group has as high incidence of
vascular lesions as the high energy based on many of us anecdotal
experience. Best regards, Zsolt  

>>> <sjasmd at aol.com> 30/07/2008 2:35 pm >>>

I would have enjoyed more discussion of the pros and cons of performing
angiography for asymptomatic knee dislocations. It would seem from the
few posts that there are some who still perform angiography. We had
begun to dismiss this procedure because of an overwhelming amount of
fairly good data published in the past decade that showed that signs of
vascular injury are almost always present when angiography is positive
in detecting popliteal artery injury and that detecting injury in the
absence of signs by angiography is uncommon. 

We recently saw an obese ?patient who dislocated her knee anteriorly who
underwent angiography three days after the injury because the orthopedic
service wanted angiography prior to planning knee repair. 
Angiography showed intraluminal thrombus and intimal flaps with thrombus
on them?in the midpopliteal artery. Luminal diameter was compromised
about 80%. Distal run-off angiography showed occlusion of the entire
posterior tibial artery and embolism of the midportion of the peroneal.
The anterior tibial artery was normal. see attached

We elected to place a stent graft over?the injured segment and trap the
thrombus under it.?We introduced? a 22 mm atrium stent and applied it
exactly at the site of the injury. Anatomical appearance returned with
good flow. 

patient was discharged the next day and will undergo elective
reconstruction of the knee.

any comments?
about use of angiography for knee dislocations
about use of stent graft in popliteal artery
about use of thrombolysis for the peroneal embolism

thanks

SAL SCLAFANI

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popliteal angiography for asymptomatic knee dislocations