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					Blunt popliteal artery injury: is physical examination alone enough for
evaluation?

Gable DR, Allen JW, Richardson JD.


Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.


Abstract

Failure to recognize popliteal artery injury and restore vessel continuity of flow after blunt trauma is a

major cause of lower-extremity amputation and morbidity. A high index of suspicion and early

recognition of the injury are paramount for limb salvage, especially with posterior knee dislocation.

Traditionally, arteriography has been the test most widely used to ensure an expedient diagnosis and

institution of appropriate treatment. More recently, some authors have tried to move away from routine

arteriography and rely on physical examination alone without arterial evaluation to guide them on their

course of treatment. Based on our experience, the presence of arterial pulses after blunt trauma and

dislocation of the knee is not an absolutely reliable indicator to exclude an arterial injury. The high

morbidity of a missed popliteal artery injury mandates arterial evaluation of the popliteal artery either by

arteriography or ultrasonography. A patient is presented with multiple injuries including a posterior knee

dislocation. He had completely normal lower-extremity pulses on initial examination and at the time of

discharge, but was required to have emergency reoperation with a ruptured popliteal artery

pseudoaneurysm 5 weeks later.

				
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