Popliteal artery trauma: A critical appraisal of an uncommon injury
Introduction
Injuries to the popliteal artery are uncommon, but have been associated with poor rates of limb salvage, as well as high levels of morbidity [1], [2], [3], [4], [5], [6]. This is most common in blunt trauma, where these sequelae are frequently the result of severe skeletal and soft tissue injuries [7]. The Royal Perth Hospital (RPH) is the largest provider of rural trauma services in the state and the second largest trauma provider in Australia. We reviewed our experience of this injury over the past 5 years and discussed a plan of management based on the findings and a review of the literature.
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Patients and methods
Records of all individuals, who presented to the RPH and had a popliteal arterial injury between August 1994 and January 2000 were collected from the prospective trauma database maintained at the RPH. This database records all trauma patients admitted to the RPH for greater than 24 h and those who died in the emergency department (ED). The data does not include those dying at the scene and in transit to RPH. Also not included are individuals under the age of 16, as the RPH only treats adult
Results
Nine patients [all male, median age 34 (17–62)] sustained a popliteal artery injury between August 1994 and January 2000. Eight cases were due to blunt trauma. The causes of injury are shown in Table 2. Demographic and clinical data are summarised in Table 3.
Most patients underwent arteriography (n=7) with the X-ray suite being the commonest venue (5/7 arteriograms). Systemic heparin (100 IU/kg) was administered in only 3/7 patients prior to clamping of the popliteal artery. Compartmental
Discussion
There is considerable disparity in the cause of popliteal artery injury from different parts of the world. In USA, penetrating trauma and gunshot wounds in particular have been shown to be the predominant cause in most studies, accounting for 30–80% of all injuries [5], [6], [10], [11], [12]. A recent study from Durban, South Africa has shown penetrating trauma (again predominantly gunshot) to be responsible for just over half (135/260 patients) of the cases [13]. Our experience mirrors that
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