[Compartment syndrome in popliteal artery injury]

Between 1973 and 1988 50 patients with injuries of the popliteal artery were treated at the Medical School of Hannover University. While 26 patients with dislocations of the knee joint had mild soft tissue injuries, most of the 24 patients with periarticular fractures of the tibia and/or femur showed excessive soft tissue damage. In both groups 11 patients who were admitted with prolonged ischemia had to undergo amputations. Primary amputations were performed according to the recommendations of. The mean duration of ischemia was 5.5 h (range 2.2-9 h) in patients with knee dislocations (n = 21); fasciotomy was performed in 14 patients (67%). In patients with popliteal artery injuries combined with fractures (n = 18) the average duration of ischemia was 6.5 h (3-13.5 h); in 16 cases in this group (89%) fasciotomy had to be performed. Fasciotomy was always necessary in patients with combined injuries of the popliteal vein and artery. Moreover, all patients with ischemia of more than 6 h duration required fasciotomy. It can be concluded that fasciotomy will probably be necessary in patients with injuries of the popliteal artery and (a) severe soft tissue damage of the thigh and/or lower leg with compartment pressure of more than 30 mmHg; (b) ischemia of more than 6 h duration; (c) combined injuries of the popliteal vein and artery; (d) reconstruction of severely injured extremities. In general, fasciotomy should always be considered after reconstruction of the popliteal artery.