High-velocity knee dislocation with vascular injury. Treatment principles

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Vascular Surgery

Background:

• High-velocity knee dislocation is a critical orthopedic emergency.
• Reduced dislocations in trauma patients often require a high index of suspicion for diagnosis.
• Associated injuries are frequently observed in patients with high-velocity knee dislocations.

Purpose of the Study:

• To outline the immediate management and surgical considerations for high-velocity knee dislocations.
• To emphasize the importance of early diagnosis and intervention for associated vascular injuries.
• To discuss strategies for optimizing long-term functional outcomes.

Main Methods:

• Immediate knee joint reduction and splinting after initial assessment.
• Prioritization of operative treatment for obvious arterial injuries, potentially foregoing delayed arteriograms.
• Consideration of spanning external fixators for temporary immobilization in specific complex cases.
• Balancing early surgical stabilization against risks in polytrauma patients.

Main Results:

• Early restoration of blood flow to ischemic limbs significantly reduces amputation rates.
• Popliteal artery injury is a common and serious complication.
• Management requires careful consideration of surgical risks versus benefits.

Conclusions:

• Prompt management, including reduction and vascular assessment, is vital.
• Selective, subacute ligament repair and bicruciate reconstruction with allografts offer the best potential for optimal knee function.
• Balancing immediate stability with long-term functional outcomes is essential.