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Todd
M. Sheils, MD, James P. Stannard, MD, Robert R. Lopez-Ben,
MD, Gerald McGwin, Jr., PhD, James T. Robinson, David A. Volgas,
MD, Birmingham, AL
Background: The purpose of this
paper was to evaluate the success of the use of physical examination
to determine the need for arteriography in a large series
of knee dislocation patients. A secondary purpose of the paper
was to evaluate the correlation between physical examination
and significant vascular injury in those patients who underwent
arteriography.
Methods: One hundred and thirty
consecutive patients who have sustained acute multi-ligamentous
knee injuries of 138 knees have been evaluated at our level
one trauma center between August 1996 and May 2002 and included
in a prospective outcome study. Four patients with four dislocations
were lost to follow-up, leaving 126 patients with 134 knee
dislocations for inclusion in this study. The results of vascular
examination of the extremities were utilized to determine
the need for arteriography. Follow-up has ranged from eight
to 48 months, with a mean of 19 months. Physical examination,
findings from magnetic resonance imaging studies, and surgical
findings were combined to determine the extent of knee ligamentous
damage.
Results: Nine patients had flow-limiting
popliteal artery damage, an incidence of seven percent. Ten
patients had abnormal physical exams (8%), with one (0.8%)
false positive and nine true positive exams. The nine patients
with popliteal artery damage had knee dislocations classified
as follows: KD-III 1; KD-IV 7; and KD-V 1. The incidence of
arterial damage based on classification was: KD-I 0%; KD-II
0%; KD-III 2%; KD-IV 16%, and KD-V 3%.
Conclusions: Selective arteriography
based on serial physical examination is a safe and prudent
policy in patients following knee dislocation. There is a
strong correlation between the results of physical examination
and the need for arteriography. Increased vigilance may be
justified in patients with a KD-IV dislocation, and serial
exams should be more frequent and last for at least 72 hours.
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