Diagnosis and treatment of traumatic popliteal artery injury

Abstract

Objective To summarize our experiences in the diagnosis and treatment of traumatic popliteal artery injury which may help orthopaedic surgeons better understand the traumatic injury to the popliteal artery in patients with knee trauma.Methods We retrospectively reviewed 113 patients with traumatic popliteal artery injury who had been admitted to our department between July 2003 and June 2012.The cohort consisted of 100 males and 13 females with a median age of 33.0 years.The type of arterial injury was A in 34 patients,B in 7 and C in 72 according to the classification proposed by Chen et al.Ninety-five patients presented with acute limb ischemia,and 18 were complicated with compartment syndrome.The popliteal arteries were primarily repaired in 94 patients,including 47 cases of end-to-end anastomosis,40 transplantations of great saphenous vein,3 transplantations of small saphenous vein,one transplantation of accompanying vein and 3 cases of thmmbectomy.Conservative treatment was conducted in 6 patients,fasciotomy in 4 and amputation in 9.The median interval between injury and revascularization was 15.8 hours for the 94 patients who had repaired the popliteal arteries and 32.0 hours for the 23 patients who had been transferred by local hospitals.Results The popliteal artery injuries were surgically repaired in 83.2％ of the cohort (94/113).Amputation was performed in 19 patients after repair,resulting in a limb salvage rate of 79.8％ (75/94).The total amputation rate was 24.8％ (28/113) and the mean interval from injury to amputation was 10.9 days (range,1 to 43 days) for this cohort.The amputations were mainly due to extensive soft tissue necrosis.Of the patients who had been previously treated at local hospital,only 21.7％ (5/23) were diagnosed as having popliteal artery injury prior to referral and 30.4％ (7/23) ultimately underwent amputation.Postoperative complications included soft tissue necrosis and infection in 22 patients,and significant elevation of serum creatine kinase in 6 patients.Conclusions Any trauma involving the knee should highly alert surgeons to a possibility of traumatic popliteal artery injury.All orthopedic surgeons should be familiar with its injury mechanisms,characteristics,clinical manifestations and differences from compartment syndrome before they can timely diagnose and repair the traumatic popliteal artery injury.Meanwhile,they should aggressively treat the concomitant increased compartment pressure. Key words: Popliteal artery; Wounds and injuries; Compartment syndromes