BLUNT POPLITEAL ARTERY INJURY - IS PHYSICAL-EXAMINATION ALONE ENOUGH FOR EVALUATION

Failure to recognize popliteal artery injury and restore vessel contin uity of flow after blunt trauma is a major cause of lower-extremity am putation and morbidity. A high index of suspicion and early recognitio n of the injury are paramount for limb salvage, especially with poster ior knee dislocation. Traditionally, arteriography has been the test m ost widely used to ensure an expedient diagnosis and institution of ap propriate treatment, More recently, some authors have tried to move aw ay from routine arteriography and rely on physical examination alone w ithout arterial evaluation to guide them on their course of treatment. Based an our experience, the presence of arterial pulses after blunt trauma and dislocation of the knee is not an absolutely reliable indic ator to exclude an arterial injury, The high morbidity of a missed pop liteal artery injury mandates arterial evaluation of the popliteal art ery either by arteriography or ultrasonography. A patient is presented with multiple injuries including a posterior knee dislocation. He had completely normal lower-extremity purses on initial examination and a t the time of discharge, but was required to have emergency reoperatio n with a ruptured popliteal artery pseudoaneurysm 5 weeks later.