Journal of Musculoskeletal Trauma

Popliteal Artery Injury Associated with Fracture and/or Dislocation of the Knee: Jun Young Yang, Kwang Jin Rhee, June Kyu Lee, Deuk Soo Hwang, Ki Yong Byun, Taek Soo Jeon; J Korean Soc Fract 2000;13(3):494-500. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.494

Abstract PDF: PURPOSE
To compare the outcome in patients who have popliteal artery injury associated with fracture and/or dislocation around the knee according to treatment option.
MATERIALS AND METHODS
We have reviewed fourteen cases of popliteal artery injury patients associated with fracture and/or dislocation injury around the knee who had visited at Chungnam National University Hospital from April 1997 to July 1999.
RESULTS
Combined skeletal injuries included fracture of distal femur, fracture of proximal tibia, and dislocation of the knee. Internal or external fixation was applied for skeletal injuries. We repaired the injured popliteal artery using end-to-end anastomosis (3 cases), interposed saphenous vein graft (9 cases), prosthetic vein graft (1 case), or thrombectomy alone (1 case). The amputation rate was 21 % (3 out of 14 patients). In limb salvage cases, we evaluated the function of knee joint, and the results were as follows : good 5 cases, fair 3 cases, and poor 3 cases.
CONCLUSION
Early diagnosis and prompt management for injuries of the popliteal artery is the most important factor to save the limb. Also, complete resection of all injured portion of vessel and reconstruction of patency through interposed saphenous vein graft are most useful method.

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Proximal Tibiosbular Fracture associated with Popliteal Artery Injury: Sang Soo Kim, Hong Jun Han, Dong Churl Kim, Dae Ho Ha, Hee Jun Yoo, Suk Kyun Park; J Korean Soc Fract 1999;12(4):885-893. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.885

Abstract PDF: Injury to the popliteal artery results in amputation more frequently than any other arterial injury. The major factor in the amputated limbs was a delay in diagnosis and therapy of the arterial injury associated with blunt trauma. The proximal tibial fractures produced the highest percentage of vascular complications and indicated immediate application of therapeutic measures. The purpose of this study is to investigate the long-term results and factors that influences the results of surgical treatment in patients with combined proximal tibial fracture and popliteal artery injury. Authors reviewed the records of 24 cases treated for this injury between January 1984 and May 1997. The age of the patients ranged from 17 to 70 years(average 45 years). Nine patients presented with life threatening injuries and classical signs of acute limb ischemia. Prolonged ischemic time ranged from 3 to 6 hours 30 minutes(average 4 hours 50 minutes). The most common cause of thoses injury was traffic accident in 16 cases. Five cases had neurologic deficit ; significant soft tissue injury was present in 14 extremities. Vascular procedures included saphenous vein interposition, end-to-end anastomosis, etc. Bony procedures were accomplished by external means in 14 cases and the others treated by immediate internal fixation in 5 cases. Intraoperative fasciotomy was performed in 5 patients with lower limb ischemia. The results suggested that limb salvage was possible in 63 percent of patients with combined proximal tibial fracture and popliteal artery injuries, but a history of life-threatening condition and severe associated injury with vascular compromise was an unfavorable prognostic factor. So a well organized multidisciplinary approach is necessary to ensure life and functional limb salvage.

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Predictors for saving the limb after popliteal artery injury: Byoung Suck Kim, Woo Sig Kim, Byoung Hynn Min, Chang Hoon Jeon, Ye Yeon Won, Dae Woong Kim, Jae In Ahn; J Korean Soc Fract 1999;12(4):879-884. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.879

Abstract PDF: PURPOSE
: This study had been performed to evaluate the factors affecting either saving the limb or amputation after popliteal artery injury associated with fractures or dislocation around the knee.
MATERIALS and METHODS
: Twelve patients of popliteal artery injury were included. Authors had analysed nine probable factors as follows - age, sex, injury mechanisms, injury types, interval between injury and time to arrive at the hospital, interval between injury and time of operation, surgical methods for revascularization, severity of extremity injuries and fasciotomy, for discrimination between the limb-saving group and the amputation.
RESULTS
Ten patients were arrived at the hospital within 48 hours after the injury. Each patient was managed by end-to-end anastomosis in 6 cases and autogenous vein graft in 4 cases and among them, 2 cases needed additional amputation for vascular compromise. All limbs could be saved in which cases operate within 6 hours after the injury. However, the limb was lost in one of 6 cases(16.7%) between 6 and 20 hours, in one of two cases(50%) over 20 hours. One of 7 cases(14.3%) with the Mangled Extremity Severity Score(MESS) of 2 to 4 points, two of 4 cases(50%) with MESS of 5 to 6 points and one(100%) with MESS of 7 points were amputated. All 4 patients associated with fasciotomy could save their limbs, however, two of 6 patients not associated with fasciotomy lost. SUMMARY : Authors thought the most reliable predictors for saving the limbs after the popliteal artery injury might include the MESS and fasciotomy, however, ischemic time more than 6 hours might not be an absolute indication for amputation.

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Reconstruction for Rupture of Popliteal Artery: Kwang Suk Lee, Young Soo Byun, Soon Hyuk Lee, Kyung Hwan Ha; J Korean Soc Fract 1997;10(1):16-24. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.16

Abstract PDF: The injury of popliteal artery is commonly produced by fracture or dislocation around the knee. Well established protocol for urgent diagnosis and treatment is essential to avoid amputation. The 14 cases of popliteal artery injury, treated between April 1987 and June 1995 at the Department of Orthopedic Surgery Korea University Hospital, were reviewed. The results were as follows. 1. In all 14 cases, 4 extremities(28%) were amputated. The amputation rate was closely correlated with the ischemic time since the accident. 2. The use of Doppler flowmeter after physical examination and emergency arteriography before exploration was recognized to be an exellent method in determination of arterial injury, 3. Among the patients who could avoid amputation(10 cases), the vein graft was performed in 8 cases(80%) and primary repair by end to end anastomosis in 2 cases(20%). 4. External fixation is recommended for its simplicity and low infection rate to provide the fixation and collateral circulation of fracture site. 5. The patients who were injured with the wide soft tissue defect by crushing could be treated by latissimus dorsi free flap transfer to avoid amputation.

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Popliteal Artery Injuries Associated with Trauma Around the Knee: Myung Chul Yoo, Chung Soo Han, Kye Lim Lee, Moon Hwan Lee; J Korean Soc Fract 1989;2(1):34-41. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.34

Abstract PDF: Between Jan. 1980 and Dec. 1987, 47 cases in 44 patients with politeal artery injury associated with trauma around the knee joint were managed at Department of Orthopaedic Surgery, KMC. Authors analysed the diagonstic methods, operations with its results and prognostic factors, and the results were as follows: 1. The incidence was 3%(44/1473) from Jan. 1980 to Dec. 1987 2. 14 cases of 19 cases, who underwent the vascular surgery, were survived(74%) and further amputations were applied to failed 5 cases. 3. Doppler flowmeter was considered as very useful diagnostic tool because of simplicity, safety, and accuracy, therefore angiography was not necessary in all cases. 4. The length of ischemic time and the amount of associated soft tissue damage were considered as important prognostic factors. 5. Vein graft was considered as good operative technique, but thrombectomy alone was not enough method for politeal artery injury. 6. ligament repair was not always necessary in treatment of popliteal artery injury associated dislocation of knee. 7. Prophylatic decompression was necessary in all cases after vascular surqery and fibulectomy fasciotomy was considered as outstanding technique.

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