title: Knee dislocation and vascular injury: 4 year experience at a UK Major Trauma Centre and vascular hub.
abstract: BACKGROUND
  Knee dislocation is a rare but potentially devastating injury. Quoted rates of associated vascular compromise vary dramatically between 3.3% and 64%, and the best approach to investigate and diagnose such an injury remains controversial. We aim to evaluate our own 4-year experience of knee dislocation and vascular injury as a UK Major Trauma Centre and vascular hub.
  
  
  METHODS
  Knee dislocation was defined as disruption of at least two major stabilising ligaments of the knee and gross instability requiring an operation. Patients were identified from the Department of Trauma and Orthopaedics patient database across a 4 year period from 2010 to 2014. Electronic patient records, imaging and hard notes were retrieved and reviewed retrospectively and relevant information recorded.
  
  
  RESULTS
  Twenty-five cases of knee dislocation were identified. Male to female ratio was 11.5:1 with a mean age of 33 years (range 17-71). One patient had a vascular injury which ultimately required a femoro-popliteal bypass graft. Twenty-four patients had documented examination findings pertaining to the vascular status of the limb. Seventeen patients had specific reference to the presence or absence of pedal pulses. The remaining seven cases were documented as either "warm well perfused" or "neurovascularly in-tact". Nine patients were discharged directly from the emergency department with outpatient follow up. All admitted cases had documented vascular examination findings the following day. Two patients had additional adjunctive non-invasive investigations. No patients were examined with duplex ultrasound, although two patients had pulses confirmed with hand-held doppler ultrasound. Three patients had an angiogram. Four cases have a documented discussion with or review from a vascular surgeon.
  
  
  CONCLUSIONS
  Our rates of vascular injury are in line with the most recent and largest study to date. Non-invasive investigation and selective angiography has been safe in identifying significant vascular compromise, however, there is inconsistency in management pathways, and too much reassurance attributed to the presence of pedal pulses on initial examination. Safety and consistency could be improved with the introduction of a formalised evidence-based protocol for the initial evaluation of knee dislocation and vascular injury.
authors.affiliation: Dept of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: simonjmparker@doctors.org.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Parker
authors.affiliation: Dept of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: ashok.handa@nds.ox.ac.uk.
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
authors.affiliation: Dept of Trauma & Orthopaedic Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: mark.deakin@ouh.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Deakin
authors.affiliation: Dept of Vascular Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: ed.sideso@ouh.nhs.uk.
authors.forename: Ediri
authors.initials: E
authors.lastname: Sideso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D015994:Incidence; D031221:Knee Dislocation / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D006113:United Kingdom / Q000453:epidemiology; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D055815:Young Adult
keywords: Angiography; Articular ligaments; Evidence-based practice; Knee dislocation; Trauma; Vascular system injuries