Garnica MME, Caballero ZC, Garnica ME, Bello GA, Vives AH, Rosas CJL

Language: Spanish
References: 30
Page: 198-203
PDF size: 177.96 Kb.

ABSTRACT

Introduction: Vascular lesion associated with knee dislocation represents a common and potentially devastating complication. A delay in revascularization that exceeds 8 hours can lead to amputation of the extremity. Therefore it is mandatory to do an immediate examination and an effective diagnosis to rule out this complication. Case report: A 19-year-old male was struck by a motor vehicle and caused traumatic dislocation of the left knee as observed on X-rays. The knee was reduced immediately. At 12 hours, the patient presented edema on the extremity and was then stabilized with external fixators. On the third day the patient developed a compartmental syndrome and artery obstruction, and required fasciotomies and revascularization of the popliteal artery. Twenty four hours later, again the artery was obstructed, conducing to supracondylar amputation. Discussion: The purpose of this article is to show that a knee dislocation, with vascular complications, may lead to extremity amputation as a drastic treatment. It is important to emphasize that vigilance of vascular permeability has to be followed every 2-3 hours, for at least 72 hours after the injury, and assisted with Doppler study. And if needed, at the moment when a pulse abnormality is detected an arteriography study must be realized.

REFERENCES

1. Green NE, Allen BL: Vascular injuries associated with dislocation of the Knee. J Bone Joint Surg Am 1977; 59: 236.

2. Jones RE, Smith EC, Bone GE: Vascular and orthopedic complications of Knee dislocation. Surg Gyn Obs 1979; 149: 554.

3. O’Donnell TF Jr, Brewster DC, Darling RC, Veen H, Waltman AA. Arterial injuries associated with fractures and/or dislocations of the knee. J Trauma 1977; 17: 775-84.

4. Shields L, Mital M, Cave EF: Complete dislocations of the Knee: Experience at the Massachusetts General Hospital. J Trauma 1969; 9: 192-215.

5. Kaufman SL, Martin LG: Arterial injuries associated with complete dislocation of the knee. Radiology 1992; 184: 153-5.

6. Varnell RM, Coldwell DM, Sangeorzan BJ, Johansen KH: Arterial injury complicating knee disruption. Am Surg 1989; 55: 699-704.

7. Treiman GS, Yellin AE, Weaver FA, Wang S, Ghalambor N, Barlow W, Snyder B, Pentecost MJ: Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg 1992; 127: 1056-63.

8. Kennedy JC: Complete dislocation of the knee joint. J Bone Joint Surg 1963; 45A: 889-904.

9. Twaddle BC, Bidwell TA, Chapman JR. Auckland Hospital, Auckland, New Zealand, and Harborview Medical Center, Seattle, Washington, USA: Knee Dislocations: Where Are the Lesions? A Prospective Evaluation of Surgical Findings in 63 Cases. Journal of Orthopaedic Trauma 2003; 17(3): 198-202.

10. Jonasch E: Traumatische verrunkung der kniegelenks. Beihefte zur Monatsschrift für Unfallheilkunde und Versicherngsmedizin, Heft 68. 1961.

11. Nikolai N: 1960. Erfabrungen bei 33 Kniegelenkverrenkungen. Langenbeks Arch Klin Chir 1960; 294: 150-72.

12. Reckling FW, Leonard F. Peltier LF: Acute knee dislocations and their complications. Clinical orthopaedics and related research. Number 2004; 422: 135-41.

13. Amelkinders LC, Dedmond BT: Outcomes of the operatively treated knee dislocation. Clin Sports Med 2000; 19: 503-17.

14. Wascher DC, Dvirnak PC, De Coster TA: Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 1997; 11: 525-9.

15. Shelbourne KD, Klootwyk TE: Low-velocity knee dislocation with sports injuries: treatment principles. Clin Sports Med 2000; 19: 443-58.

16. Stayner LR, Coen MJ: Historic perspective’s of treatment algorithms in knee dislocation. Clin Sports Med 2000; 19: 399-413.

17. Meyers MH, Harvey JP: Traumatic dislocation of the Knee joint. J Bone Joint Surg Am 1971; 53: 16.

18. Hoover NW: Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am 1961; 41: 1099-1112.

19. Meyers MH, Moore TM, Harvey JP: Follow-up notes on articles previously published in the journal: Traumatic dislocation of the knee joint. J Bone Joint Surg 1975; 57A: 430.

20. Montgomery JB: dislocation of the knee. Orthop Cli North Am 1987; 18: 149.

21. Muscat W, Rogers W, Cruz A, et al: Arterial injuries in orthopedics: True posteromedial approach for vascular control about the knee. J Orthop Trauma 1996; 10: 476.

22. Shelbourne KD, Porter DA, Clingman JA: Low velocity knee dislocation. Orthop Rev 1991; 20: 995.

23. Kendall RW, Taylor DC, Salvian AJ, et al: The role of arteriography in assessing vascular injuries associated with dislocations of the knee. J Trauma 1993; 35: 875.

24. Miranda FE, Dennis JW, Veldenz HC, Dovgan PS, Frykberg ER: Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: A prospective study. J Trauma 2002; 52: 247-52.

25. Makris S, Papadoulas S, Mantelas M, Zervakis G, Boudouris J, Pavlides P, Kotsis Th, Bessias N: Department of vascular surgery, red cross hospital of Athens. Popliteal artery injury associated with knee dislocation. Our 6-year experience. J Bone Joint Surg 2004; 86: 431-9.

26. Barnes CJ, Pietrobon R, Higgins LD: Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma 2002; 53: 1109-14.

27. Gable DR, Allen JW, Richardson JD: Blunt popliteal artery injury: is physical examination alone enough for evaluation? J Trauma 1997; 43: 541-4.

28. Wascher DC, Dvirnak PC, DeCoster DC: Knee dislocation initial assessment and implications for treatment. J Orthop Trauma 1997; 11: 525.

29. Schenck RC: Classification and treatment of knee dislocations. Orthopeadic Special Education 1998; 4: 35.

30. Shehadi WH: Adverse reactions to intravascularly administered contrast media. A comprehensive study based on a prospective survey. Am J Roent Rad Ther Nucl Med 1975; 124(1): 145-52.