Popliteal artery injury following fracture or dislocation at the knee. Diagnosis and management

Abstract

Fracture dislocations or dislocations of the knee can produce an arterial injury that may be difficult to evaluate clinically. Aggressive diagnosis and treatment can produce satisfactory results in both vascular and orthopedic situations if performed early after the injury. Five cases of popliteal arterial injury were seen from April 1974 to August 1976. Three cases were following posterior knee dislocation, one was a femoral fracture displacement, and one was a rotary tibiofibular displacement. Four of the patients had complete popliteal artery transection and one had intramural hematoma and spasm. Initial diagnosis of severe arterial injury, although suspicious on clinical grounds, was not conclusive. Use of a Doppler flowmeter and arteriography was essential for the diagnosis of arterial injury. Peroneal nerve injury was present in two of five patients. Vascular surgery was successful in all cases. Skeletal instability was corrected at the time of vascular exploration, usually through same incision. Leg compartment edema or hematoma was common, but responded to fasciotomy in all cases. Vein graft reconstruction was preferred to direct repair because of wall contusion and the need for additional vessel length over edematous and contused tissue. Acceptable knee stability was obtained from initial repair in all cases.