BLUNT POPLITEAL ARTERY TRAUMA - A CHALLENGING INJURY

Blunt popliteal artery trauma is a challenging injury, particularly wh en associated with major soft tissue damage. We reviewed our experienc e with this injury to determine If the incidence of vascular injury as sociated with fractures and/or dislocations about the knee, 2) the inc idence of limb loss, and 3) factors associated with amputation. We tre ated 37 patients with 38 blunt popliteal artery injuries and either fr actures about the knee or posterior knee dislocations. Patients who un derwent primary amputations were excluded. The incidence of popliteal artery injuries with fractures about the knee tvas 3 per cent, whereas 16 per cent of patients with posterior knee dislocations had vascular injuries (P <0.05). Amputations were required in 14 of the 38 injured limbs (36%). None of these patients had a pulse or Doppler signal on admission, and 13 had major soft tissue injury. No patient with a puls e or Doppler signal lost a limb (P <0.05). Limb loss was primarily rel ated to limited venous outflow and/or severe infection in damaged tiss ue. Failure of the arterial repair rarely led to amputation, particula rly in recent years. Two patients with angiographically proven arteria l injuries were treated nonoperatively without complications. The inci dence of vascular injuries associated with fractures about the knee is low, but somewhat higher with posterior knee dislocations. The overal l 9 per cent rate of positive angiograms suggests that a selective app roach may be indicated. The amputation rate remains high, but it has i mproved with an integrated, multidisciplinary team approach. In patien ts without a pulse or Doppler signal and with severe soft tissue injur ies, primary amputation may be appropriate.