2017 ISAKOS Biennial Congress ePoster #1820
Detection of Vascular Injury In Knee Dislocation: Risk Factors and Diagnostic Tools
Ronald L. Diercks, Prof, MD, PhD, Groningen, Groningen NETHERLANDS
Duncan E. Meuffels, MD, PhD, Rotterdam NETHERLANDS
Astrid Edema, MD, Groningen, Groningen NETHERLANDS
Groningen University Medical Center , groningen, NETHERLANDS
FDA Status Not Applicable
A guideline is developed to asses the risk on vasular injury in knee dislocation, in which patient chracteristics, injury mechanism, injury classification and physical signs are combined to support the clinician. In suspected vascular injury, CT angiography is the imaging of choice.
Purpose. Knee dislocation and vascular injury are known to be misdiagnosed. Vascular injury is the most serious and limb threatening injury accompanying knee dislocation.. From a retrospective cohort of 64 patients and a systematic lterature review we constructed a stepwise gudeline for a reliable and cost-effective diagnosis of vasular injury.
Injury, diagnosic methods and patient characteristics in 64 patients treated at 2 major trauma centers in the Netherlands were evaluated,, in relation to vasular injury.
Clear risk factors for vascular injury and by that indications for vascular imaging are: hard signs of ischemia, an irreducible knee dislocation, or the presence of an accompanying nerve lesions. Injuries involving the lateral side of the knee , bicruciate and posterolateral lesion and bicruciate lesion with additional fracture showed a higher incidence of vascular injury. High-energy injuries have a greater risk on vascular injuries than low-energy ( sports) injuries, but in ultra-low energy trauma especially a high level of suspicion and a low threshold for vascular imaging is indicated
A review of the litterature showed that physical signs like palpation of distal arterial pulsations, Ankle-Brachial Index and Duplex scanning leads to underdiagnosis of vascular injury; CT Angiography is the imaging technique of choice for detection of vascular injuries in knee dislocations. The risk of amputation after a delay of more than 8 hours between injury and intervention, is lower than reported in earlier studies.
Based on patient characteristics, injury level, injury classification and the literature review we developed an algorithm that supports a patient specific, cost-effective, safe and reliable diagnostic pathway.