Green and Allen analyzed 245 complete knee dislocations — 41 new cases plus 204 from the literature — to define the frequency and urgency of popliteal artery injury. The central question: how much time do you have before the limb is unsalvageable?
Reduce the knee dislocation, then immediately check posterior tibialis AND dorsalis pedis pulses. If pulses do not return after reduction, the patient goes to the OR — not to observation, and not to arteriography that will consume critical minutes.
If arteriography is obtained, it must not push your anastomosis past 6 hours (hard ceiling: 8 hours). The data are unambiguous: every hour past 8 swings the odds from 89% salvage to 86% amputation.
Do not be reassured by a warm foot. Skin requires far less perfusion than muscle. A warm, pulseless extremity is a limb in the process of dying, not a limb in spasm. Green and Allen directly refuted the spasm hypothesis with this dataset.
At the time of arterial repair, perform prophylactic fasciotomy. Reperfusion swelling is predictable, and compartment syndrome on top of a fresh vascular repair is a complication you can prevent at the same operation.
Green and Allen analyzed 245 complete knee dislocations — 41 new cases plus 204 from the literature — to define the frequency and urgency of popliteal artery injury. The central question: how much time do you have before the limb is unsalvageable?
Reduce the knee dislocation, then immediately check posterior tibialis AND dorsalis pedis pulses. If pulses do not return after reduction, the patient goes to the OR — not to observation, and not to arteriography that will consume critical minutes.
If arteriography is obtained, it must not push your anastomosis past 6 hours (hard ceiling: 8 hours). The data are unambiguous: every hour past 8 swings the odds from 89% salvage to 86% amputation.
Do not be reassured by a warm foot. Skin requires far less perfusion than muscle. A warm, pulseless extremity is a limb in the process of dying, not a limb in spasm. Green and Allen directly refuted the spasm hypothesis with this dataset.
At the time of arterial repair, perform prophylactic fasciotomy. Reperfusion swelling is predictable, and compartment syndrome on top of a fresh vascular repair is a complication you can prevent at the same operation.