Popliteal artery trauma: a high risk injury

The clinical presentation and management of 28 popliteal artery injuries following penetrating and blunt trauma during a 6 year period is reviewed. Clinical and Doppler evaluation identified an arterial injury in 24 (85 per cent) patients. In eight (29 per cent) patients with arteriovenous fistulae or false aneurysms, pedal pulses were palpable during initial assessment. Three (10.7 per cent) patients had limb amputation attributable to delayed vascular repair, crush injury and sepsis. End-to-end arterial repair following blunt trauma resulted in early failure with thrombosis in two patients. Autogenous vein grafting was used in 12 patients and is advocated in all blunt popliteal arterial injuries. Routine repair of associated venous injuries and liberal criteria for early fasciotomy were used. Exoskeletal fixation or skeletal traction for compound and comminuted fractures is recommended for simplicity of application and wound management. The significant functional orthopaedic disability following blunt arterial trauma at the knee is emphasized.