title: Characteristics and clinical outcome in patients after popliteal artery injury.
abstract: BACKGROUND
  The treatment of popliteal artery injury (PAI) caused by blunt or penetrating mechanism is demanding. Concomitant injuries and prolonged ischemia are the major causes of lower extremity morbidity and poor rates of limb salvage. This study assessed the amputation rate and, subsequently, the therapeutic management and clinical outcomes regarding the affect of concomitant injuries among patients with PAI in a setting of central European trauma care.
  
  
  METHODS
  Sixty-four patients (20 female and 44 male), with an average age of 44 years (range, 17-79 years) at the time of injury, were evaluated for clinical characteristics, concomitant injuries, complications, amputation rates, and functional outcome after traumatic PAI. The mechanism of injury was blunt trauma in 35 patients (54.7%) and penetrating trauma in 29 (45.3%). The Mangled Extremity Severity Score and the Injury Severity Score were assessed initially and the modified Functional Independence Measure (FIM) Score at 12 months after the primary surgery.
  
  
  RESULTS
  Thirty patients (47%) returned to their normal activity level within 1 year after trauma, and 16 (25%) were limited in their daily activity or suffered from chronic pain symptoms. Within the blunt trauma group 26 of 35 patients (74%) sustained severe concomitant injuries, whereas two of 29 patients (7%) in the penetrating group showed severe concomitant injuries (P < .046). Eleven patients (17%) had to undergo revision surgery due to their associated injuries. The median modified FIM score was 10.3, whereas patients with blunt trauma had significantly lower FIM score (P < .0082). The median Mangled Extremity Severity Score was 6 points (range, 6-16 points). Primary or secondary amputation was required in 18 patients (28%) due to failure of revascularization. Patients who sustained blunt trauma had significantly higher amputation rates than those with penetrating injuries (P < .035).
  
  
  CONCLUSIONS
  Clinical outcome and limb salvage of patients with PAI were influenced by the mechanism of trauma, concomitant injuries, prolonged ischemia time, and the type of surgical procedure. Patients after blunt trauma had a higher incidence of concomitant injuries, and (comminuted) fractures or knee dislocations and severe soft tissue damage had the highest effect on the amputation rate.
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: nikolaus.lang@meduniwien.ac.at.
authors.forename: Nikolaus W
authors.initials: NW
authors.lastname: Lang
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Julian B
authors.initials: JB
authors.lastname: Joestl
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Platzer
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects; D001317:Austria; D059350:Chronic Pain / Q000209:etiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D011150:Popliteal Artery / Q000293:injuries / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult