Examination of the patient with a knee dislocation. The case for selective arteriography
G. S. Treiman, A. E. Yellin, F. A. Weaver, S. Wang, N. Ghalambor, W. Barlow, B. Snyder and M. J. Pentecost
Department of Surgery, Los Angeles County-University of Southern California Medical Center 90033.
One hundred fifteen patients with a unilateral knee dislocation underwent
arteriography to examine the popliteal artery. The incidence of popliteal
artery injury was 23% (27 patients). Clinically, 29 (25%) of the 115
patients had an abnormal ipsilateral pedal pulse and 23 (79%) of these 29
patients had an arteriographically identified popliteal artery injury.
Twenty-two arteries were surgically repaired and one was treated without
surgery. Eight-six patients had normal pulses; the arteriogram showed no
abnormalities in 77, demonstrated spasm in five, and revealed an intimal
flap in four. All 86 patients were treated without surgery and had no
delayed vascular complications. This demonstrates that the vascular
examination is an accurate predictor of major popliteal artery injury
following knee dislocation. Patients with an abnormal pedal pulse warrant
arteriography due to a high incidence (79%) of popliteal artery injury.
Patients with normal pulses may be monitored by clinical examination only.
Popliteal artery injuries in this group are minor and rarely require
intervention.
