Death after closed adolescent knee injury and popliteal artery occlusion: a case report and clinical review

Abstract

A healthy adolescent male soccer player sustained a radiograph-negative, effusion-negative physeal injury of the proximal tibia from a ground-level fall with traumatic occlusion of the popliteal artery. Orthopaedic evaluation and arteriography were delayed for 72 hours after the injury. He arrived at a tertiary referral center in multisystem organ failure secondary to lower extremity ischemic necrosis, septic pulmonary thromboembolism, and systemic shock. Emergent medical evaluation, a high index of suspicion, and a careful neurovascular examination are imperative after every closed knee injury in the young athlete.

Keywords: dislocation; injury; occlusion; pediatric knee; popliteal artery; proximal tibia fracture.

Figure 1.

Antero-posterior (AP) and lateral radiographs of the affected right knee 3 days after closed injury. The AP view shows a congruent joint line, no interruptions of the subchondral or metaphyseal bone, regular physeal morphology, and normal tibiofemoral alignment. The lateral projection is slightly caudad without disruption of the tibial apophysis, the physeal line, or the posterior cortex through the physis. No significant effusion was present.

Figure 2.

Representative axial cut from a computed tomography angiogram of the chest 3 days after knee injury demonstrating the right pneumothorax with scattered cavitary lesions, filling defects, and focal hemorrhages.

Figure 3.

Sequential antero-posterior fluoroscopic images of the right lower extremity at the level of the knee joint 4 days after injury. There is an acute cutoff of the popliteal artery at the level of the knee joint with small faint and slow-filling collaterals. There is no reconstitution of the popliteal or any of the named tibial vessels.