Jeffrey D Hollis1, Brian J Daley. 1. Department of Surgery, Division of Trauma and Critical Care, University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee 37920, USA.
Abstract
BACKGROUND: Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations. METHODS: We conducted an institutional review board-approved retrospective review of patients admitted at a university-based Level I trauma center with knee dislocations from January 1, 1993, to December 31, 2002. Thirty-nine patients (28 male patients and 11 female patients; average age, 42.8 years) had 39 dislocations (27 left and 12 right, 26 posterior and 13 anterior). Most patients (n = 25) were involved in motor vehicle crashes. All patients underwent arteriography. RESULTS: Of the 20 normal arteriograms, all had normal PE. Of the 19 abnormal arteriograms, 8 had a normal PE and 11 were abnormal. Within this subgroup, none of the 8 with normal PE required surgery, whereas 7 of the 11 with abnormal PE required surgery. None of the nonoperative patients had vascular complications during the hospital stay. Sensitivity and specificity were 100% for PE on surgically significant vascular injury. CONCLUSION: Routine arteriography is unnecessary in patients with a normal PE after reduction of the knee dislocation.
BACKGROUND: Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations. METHODS: We conducted an institutional review board-approved retrospective review of patients admitted at a university-based Level I trauma center with knee dislocations from January 1, 1993, to December 31, 2002. Thirty-nine patients (28 male patients and 11 female patients; average age, 42.8 years) had 39 dislocations (27 left and 12 right, 26 posterior and 13 anterior). Most patients (n = 25) were involved in motor vehicle crashes. All patients underwent arteriography. RESULTS: Of the 20 normal arteriograms, all had normal PE. Of the 19 abnormal arteriograms, 8 had a normal PE and 11 were abnormal. Within this subgroup, none of the 8 with normal PE required surgery, whereas 7 of the 11 with abnormal PE required surgery. None of the nonoperative patients had vascular complications during the hospital stay. Sensitivity and specificity were 100% for PE on surgically significant vascular injury. CONCLUSION: Routine arteriography is unnecessary in patients with a normal PE after reduction of the knee dislocation.
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