Are evidence-based protocols which identify vascular injury associated with knee dislocation underutilized?
A concerning number of patients referred to our clinic with knee dislocations have not been thoroughly evaluated for popliteal injury. The objective of this study is to present our experience and attempt to identify possible causes for this trend. Thirty-one consecutive patients with knee dislocations referred over a 1-year period were evaluated. Patients were assigned to either of two groups: Group I included all patients initially evaluated with an evidence-based protocol for identifying clinically significant vascular injury associated with knee dislocation, and Group II included all patients who had not received an evidence-based evaluation. The main outcome measure was delay in the diagnosis of a limb threatening vascular injury (>8 h) within each group. Six out of the 31 patients referred, were evaluated for vascular injury without an evidence-based protocol. These patients were significantly more likely to have had a delay in the diagnosis of their vascular injury beyond 8 h (P = 0.032) and were less likely to have been evaluated at a level I trauma center (P < 0.001). As expected, evidence-based protocols are superior when compared to initial pedal pulse examination alone for identifying surgically significant vascular injury within 8 h. The consequences of a delay in diagnosis beyond 8 h can be catastrophic and one patient in this series required an above-knee amputation. This is not new information, however, a significant number of patients with knee dislocations continue to be evaluated solely by initial pedal pulse examination. Though effective protocols exist, orthopedic surgeons must work to facilitate the implementation of these protocols at their referring institutions.
Nicandri
Gregg T
GT
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA. Gregg_Nicandri@URMC.rochester.edu
Dunbar
Robert P
RP
Wahl
Christopher J
CJ
D000328:Adult; D000465:Algorithms; D019917:Blood Vessel Prosthesis Implantation; D002985:Clinical Protocols; D057210:Delayed Diagnosis; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D031221:Knee Dislocation / Q000150:complications* / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries; D008297:Male; D010808:Physical Examination; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011674:Pulse; D011859:Radiography; D014193:Trauma Centers; D014463:Ultrasonography