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Amro C, Parekh AT, Diamond K, Lissauer ME, Butts CA. Traumatic Popliteal Artery Occlusion Following Lower Extremity Crush Injury Presenting With Isolated Patellar Dislocation. Am Surg 2023:31348231160846. [PMID: 36871965 DOI: 10.1177/00031348231160846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
While traumatic popliteal artery injury historically has a low incidence, failure to acutely recognize the vascular insult poses a significant risk of limb loss and functional impairment. A 71-year-old male presented with left lower extremity pain in setting of a crush injury working underneath a vehicle resulting in an isolated lateral dislocation of his patella and complete occlusion of the distal popliteal artery. He was taken to the operating room for an in-situ bypass and four-compartment fasciotomy. His hospital stay included three staged washouts/debridements with eventual closure. He was discharged after 38 days to a rehabilitation facility with ability to self-ambulate with assistance within one month. This patient's presentation is unique for his isolated patellar dislocation without associated injuries characteristically associated with a traumatic vascular injury of the popliteal artery and serves to remind the importance of complete examination in the setting of blunt trauma.
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Affiliation(s)
- Chris Amro
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Akshat T Parekh
- Department of Orthopedic Surgery, 8395Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Keith Diamond
- Department of Orthopedic Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Matthew E Lissauer
- Department of Surgery, 12227University of Connecticut School of Medicine, Hartford, CT, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Hsieh YH, Lee MC, Hsu CC, Chen SH, Lin YT, Lin CH, Lin CH. Popliteal Artery Injury After Fracture and/or Dislocation of the Knee: Risk Stratification for Revascularization Outcome. Ann Plast Surg 2022; 88:S50-S55. [PMID: 35225847 DOI: 10.1097/sap.0000000000003076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Managing complex knee trauma involving both vascular and osseous injuries is challenging, yet the available guidelines for efficient popliteal artery injury management after high-velocity blunt knee trauma remain conflicting and inconsistent. In this study, the authors aim to identify the risk factors associated with delayed limb amputation and ischemic muscular sequela postrevascularization. Furthermore, we propose a treatment algorithm to improve the limb salvage rate. METHODS Patients who presented with traumatic popliteal artery injury resulting in vessel occlusion or rupture, followed by fracture and/or dislocation of the knee from January 2008 to December 2013, were included for retrospective review. RESULTS Overall delayed amputation rate was 24% (7/29) and 16% (4/25) after successful revascularization. Mangled Extremity Severity Score is higher in the delayed amputation group than the limb-salvaged group (P = 0.02). Higher-impact force (P = 0.03), ischemic limb on presentation (P = 0.03), prolonged ischemia time (P = 0.04), unstable hemodynamics (P = 0.01), longer operation time (P = 0.04), and prolonged intensive care unit stay (P = 0.03) are risk factors of delayed amputation. Longer ischemia time (P = 0.04) and length of popliteal artery injury (P = 0.02) are associated with ischemic muscular sequela. CONCLUSIONS Mangled Extremity Severity Score is a reliable predictor of limb salvage. An algorithmic approach may improve the outcome of popliteal artery injury after high-velocity blunt knee trauma.
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Affiliation(s)
- Yun-Huan Hsieh
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
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Coffman JR, Moffatt DC, Foreman MA. Popliteal Artery Entrapment within a Tibial Plateau Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00001. [PMID: 34613936 DOI: 10.2106/jbjs.cc.21.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Tibial plateau fractures can be associated with arterial injuries or dysvascular limbs, particularly in settings of trauma. Dysvascular limb in the setting of fracture is commonly due to dissection of the artery. Entrapment of the artery within the fracture is rare. We report a 48-year-old man who presented with left popliteal entrapment within a left tibial plateau fracture status-post external fixation and stent placement in the popliteal artery. CONCLUSION Findings from this case highlight entrapment of an artery as a mechanism of a dysvascular limb in the setting of high-energy lower-extremity fractures and specifically for tibial plateau fractures.
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Affiliation(s)
- Jason R Coffman
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - David C Moffatt
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Mark A Foreman
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Liu YW, Li YH, Yu T, Yang T, Li Y, Tan L. Popliteal artery transection associated with a minimally displaced tibial plateau fracture: a case report and review of the literature. BMC Musculoskelet Disord 2020; 21:59. [PMID: 32000749 PMCID: PMC6993439 DOI: 10.1186/s12891-020-3089-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Poplital artery transection injury is potentially catastrophic, or even life-threatening. Severe traumas, including open fracture, gunshot, stabs, and knee dislocation and complex fracture of proximal tibia or distal femur, are the common causes of high rate of amputation due to popliteal artery trauma. No report mentions vascular injury associated with minimally displaced tibial plateau fracture in adult. CASE PRESENTATION A 30-year-old male presented with popliteal artery transection injury associated with minimally displaced tibial plateau fracture. He presented to emergency department, 6 h after fall from ground into a 1-m height hole. Physical examination suggested acute ischemia, with signs of paleness, coldness, anesthesia, hemorrhagic bullae below the right knee level. There was severe swelling and ecchymosis in popliteal fossa and around the leg with significant calf tenderness and pedal edema. Tibialis posterior, dorsalis pedis, and popliteal arterial pulses were not palpable. Radiograph suggested minimally displaced tibial plateau fracture with no evidence of knee dislocation. The patient was taken up for emergency surgery after consultation with vascular surgeon. During the closed reduction external fixation and compartment decompression, popliteal artery trunk was found transected and end-to-end repair was performed. During the post-operational period, no complication was developed and the patient was followed-up for 1 year. At the one-year follow-up, he acquired good stability of his right knee with full range of motion. CONCLUSION Significant swelling and ecchymosis should alert the surgeons to the possibility of vascular injury in knee joint injury, even if there is no fracture or dislocation, or fracture is minimally displaced.
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Affiliation(s)
- Yan-Wei Liu
- Department of Orthopedic Trauma, The First Hospital of Jilin University, Changchun, No. 71 Xinmin Street, Changchun, Jilin, China
| | - Yan-Hui Li
- Department of Cardiology and Echocardiography, the First Hospital of Jilin University, Changchun, 130021, China
| | - Tiecheng Yu
- Department of Orthopedic Trauma, The First Hospital of Jilin University, Changchun, No. 71 Xinmin Street, Changchun, Jilin, China
| | - Tianye Yang
- Department of Plastic and Cosmetic Surgery, the First Hospital of Jilin University, Changchun, 130021, China
| | - Yuying Li
- Department of Hematology, the First Hospital of Jilin University, Changchun, 130021, China
| | - Lei Tan
- Department of Orthopedic Trauma, The First Hospital of Jilin University, Changchun, No. 71 Xinmin Street, Changchun, Jilin, China.
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Goos JAC, Emmink BL, Nieuwenhuis D, Bosman WM. Hoffa fracture accompanied by dissection of the popliteal artery. BMJ Case Rep 2019; 12:12/12/e232348. [PMID: 31818893 DOI: 10.1136/bcr-2019-232348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
After a high-energy trauma, a 37-year-old motorcyclist presented to the emergency ward with a Hoffa fracture of the lateral femoral condyle of the right knee. Following admission, the patient developed a pale, cold and pulseless right foot. CT angiography scan showed a 5 cm dissection of the popliteal artery. Emergency arterial reconstruction was performed and the Hoffa fracture was repaired in a second stage. To our knowledge, this is the first report of a patient with a Hoffa fracture accompanied by a popliteal artery dissection.
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Affiliation(s)
| | - Benjamin Lucas Emmink
- Trauma Surgery, St Antonius Hospital, Nieuwegein, The Netherlands .,Trauma Surgery, Medisch Centrum Haaglanden Westeinde, Den Haag, The Netherlands
| | | | - Willem-Maarten Bosman
- Trauma Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Trauma Surgery, Albert Schweitzer, Dordrecht, The Netherlands
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Decreased National Rate of below the Knee Amputation in Patients with Popliteal Artery Injury. Ann Vasc Surg 2018; 57:1-9. [PMID: 30053552 DOI: 10.1016/j.avsg.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/01/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Popliteal arterial injury (PAI) is the second most common infrainguinal arterial injury after femoral artery injury with an incidence < 0.2%. A 2003 analysis of the National Trauma Data Bank (NTDB) reported a below the knee amputation (BKA) rate of 7.1% in patients with PAI as well as higher risk in those with an associated fracture or nerve injury. Given advances in vascular surgical techniques, improved multidisciplinary care, and expeditious diagnosis with computed tomography angiography, we hypothesized that the national rate of BKA in patients with PAI has decreased and sought to identify risk factors for BKA in patients with PAI. METHODS A retrospective analysis of the NTDB was performed from 2007 to 2015. Patients ≥15 years of age with PAI were included and grouped by mechanism of injury (blunt versus penetrating). Interfacility transfers were excluded. The primary outcome of interest was BKA. Univariable and multivariable analyses were performed to identify predictors of BKA in patients with PAI. RESULTS From 4,385,698 patients, 5,143 were identified with PAI (<0.2%) with most involved in a blunt mechanism (56.8%). The overall limb loss rate was 5.1% (decreased from 7.1% in 2003, P = 0.0037). After adjusting for covariates, a blunt mechanism (odds ratio [OR] = 3.53, confidence intervals [CI] = 2.49-5.01, P < 0.001) and open proximal tibia/fibula fracture or dislocation (OR = 2.71, CI = 2.08-3.54, P < 0.001) were independent risk factors for BKA in patients with PAI. A combined popliteal vein injury (PVI) did not increase the risk for BKA (P = 0.64). CONCLUSIONS The national rate of limb loss in trauma patients with PAI has decreased from 7.1 to 5.1%. A blunt mechanism of injury as well as proximal open tibia/fibula fracture or dislocation continue to be the independent risk factors for BKA. Confirming a previous report, we found a combined PVI not to be associated with higher risk for BKA. Future prospective research to determine other possible contributing factors such as intraoperative hemodynamics and utilization of vascular shunt and fasciotomy appears warranted.
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Góes Junior AMDO, Rodrigues ADV, Braga FB, de Andrade MC, Abib SDCV. Vascular trauma in the Amazon - the challenge of great distances. Rev Col Bras Cir 2015; 42:244-52. [PMID: 26517800 DOI: 10.1590/0100-69912015004009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/05/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the incidence of unfavorable outcomes in vascular trauma patients and their possible correlation to the distance between the city where the injury was sustained and the hospital where the patient received definitive treatment. METHODS descriptive and retrospective study. Data were collected from medical records of patients submitted to surgical procedures for arterial or venous injuries from February 2011 to February 2013 at the only trauma center providing vascular surgery in a vast area of the Amazon region. Trauma date, patient gender and age, mechanism and anatomic topography of injury, surgical management, need for surgical re-intervention, hospitalization period, postoperative complications, mortality and limb amputation rates were analyzed. The incidence of unfavorable outcomes was assessed according to the distance between the city where the vascular injury was sustained and the trauma center. RESULTS One hundred seventy-three patients with 255 vascular injuries were analyzed; 95.95% were male (p<0.05), mean age of 28.92 years; 47.4% were caused by firearm projectiles (p<0.05); topographic distribution: 45.66% lower limbs (p<0.05), 37.57% upper limbs, 6.94% abdominal, 5.2% thoracic and 4.62% were cervical vascular injuries; 51.42% of patients required hospitalization for seven days or less (p<0.05); limb amputation was necessary in 15.6% and the overall mortality was 6.36%. CONCLUSION distances greater than 200 Km were associated to longer hospitalization period; distances greater than 300 Km were associated to increased limb amputation probability; severe vascular trauma have an increased death probability when patients need to travel more than 200 Km for surgical treatment.
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Imerci A, Ozaksar K, Gürbüz Y, Sügün TS, Canbek U, Savran A. Popliteal artery injury associated with blunt trauma to the knee without fracture or dislocation. West J Emerg Med 2015; 15:145-8. [PMID: 24672601 PMCID: PMC3966444 DOI: 10.5811/westjem.2013.12.18223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 11/26/2013] [Accepted: 12/05/2013] [Indexed: 12/05/2022] Open
Abstract
Popliteal artery injuries are frequently seen with fractures, dislocations, or penetrating injuries. Concern about arterial injury and early recognition of the possibility of arterial injury is crucial for the salvage of the extremity. This article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating injury, knee dislocation, fracture, or high-velocity trauma mechanism. The importance of a detailed vascular examination of a blunt trauma patient is emphasized.
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Affiliation(s)
- Ahmet Imerci
- Erzurum Palandoken State Hospital, Department of Orthopaedics and Traumatology, Erzurum, Turkey
| | - Kemal Ozaksar
- Hand Microsurgery Orthopaedic Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Yusuf Gürbüz
- Hand Microsurgery Orthopaedic Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Tahir Sadik Sügün
- Hand Microsurgery Orthopaedic Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Umut Canbek
- Mugla Sitki Kocman University of Medicine, Department of Orthopaedics and Traumatology, Mugla, Turkey
| | - Ahmet Savran
- Izmir Tepecik Education and Research Hospital, Department of Orthopaedics and Traumatology, Turkey
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Characteristics and clinical outcome in patients after popliteal artery injury. J Vasc Surg 2015; 61:1495-500. [DOI: 10.1016/j.jvs.2015.01.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Vielgut I, Gregori M, Holzer LA, Glehr M, Hashemi S, Platzer P. Limb salvage and functional outcomes among patients with traumatic popliteal artery injury: a review of 64 cases. Wien Klin Wochenschr 2015; 127:561-6. [DOI: 10.1007/s00508-015-0715-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
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de Oliveira Góes Jr. AM, Rodrigues ADV, Braga FB, de Andrade MC, de Campos Vieira Abib S. VASCULAR TRAUMA IN THE AMAZON REGION: A TWO YEARS CASES REVIEW FROM A SINGLE INSTITUTION. Health (London) 2014. [DOI: 10.4236/health.2014.66071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shi L. The delayed management of main arterial injuries in extremity trauma: Surgical challenges and outcomes. Pak J Med Sci 2013; 29:64-7. [PMID: 24353509 PMCID: PMC3809202 DOI: 10.12669/pjms.291.2619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/18/2012] [Accepted: 10/20/2012] [Indexed: 12/02/2022] Open
Abstract
Objective: To analyse the early outcome of main arterial injuries with delayed treatment in extremity trauma and help vascular surgeons in determining proper treatment strategy for such injuries. Methodology: Forty-three patients with delayed treatment of main arterial injuries during May 2003 and January 2008 were reviewed retrospectively. Results: In 43 patients, injuries were caused by blunt trauma in 26 cases and penetrating trauma in 17 cases. The maximum ischaemia time was 38 hours and the minimum was 13 hours. Eight patients underwent primary amputations and four patients underwent secondary amputation. There was no perioperative mortality, while wound infection occurred in five patients, followed by graft occlusion in four patients, arteriovenous fistulae in two patients and pseudoaneurysm in one patient. Conclusion: The delayed intervention in main arterial injuries is associated with higher risk of amputation, while the suitable surgical techniques may decrease the risk of limb loss. Viable limbs should be revascularized in otherwise stable patients even with long periods of ischaemia.
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Affiliation(s)
- Liguo Shi
- Liguo Shi, MD, Department of Surgery Emergency, Tianjin 4 Centre Hospital, Tianjin, 300140, China
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Bakia JM, Tordoir JHM, van Heurn LWE. Traumatic dissection and thrombosis of the popliteal artery in a child. J Pediatr Surg 2012; 47:1299-301. [PMID: 22703810 DOI: 10.1016/j.jpedsurg.2012.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/27/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
Injuries of the popliteal artery have the highest rate of limb loss compared with other peripheral vascular injuries. Particularly, blunt popliteal artery trauma is known to be associated with a high rate of amputation. Traumatic vascular injuries are usually associated with dislocations and fractures. We describe the radiographic findings as well as the delayed presentation and management of a crush injury of the left leg in an 8-year-old girl resulting in dissection of the popliteal artery without a dislocation or fracture.
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Affiliation(s)
- J-M Bakia
- Department of Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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