Knee joint penetrating trauma associated with complete popliteal artery transection without fracture or joint dislocation: Diagnostic challenge in the resource-limited facility; a case report

Abstract

Introduction: Popliteal artery injuries are frequently seen with fractures and dislocations. In the setting of trauma is a rare but highly comorbid condition associated with significant long-term disability, limb loss, and even mortality. Literature suggests that vascular damage occurring with injury of the lower extremity is rare and uncommon. Case presentation: We present a case of 37 years old male patient who had popliteal injury on the left knee joint with undisplaced and non-dislocated tibiofemoral joint 8 h after an injury. He underwent surgery at our facility and intraoperatively was found to have a transected popliteal artery. The mechanism of injury was unclear. Surgical debridement was done, systemic heparinization followed by an end to end popliteal artery anastomosis that resulted into well perfusion of the distal limb. Discussion: Popliteal artery injuries remain a challenging entity that carries the greatest risk of morbidity. Surgical management of popliteal vascular injury continues to be of great needs. This follows after an early and accurate clinical and radiological diagnosis of vascular injury. The computed tomography angiography with intravascular contrast injection and arterial venous ultrasound are the ideal modalities for diagnosing vascular injuries. Popliteal artery anastomosis and systemic heparinization add more value in managing a transected popliteal artery. Postoperative use of heparin is advocated after a successfully primary anastomosis. Conclusion: Despite major efforts in establishing protocols and guidelines in the management of vascular trauma, optimal strategies of traumatic popliteal artery injuries are still under investigated. Clinical evaluation of popliteal artery injury can readily overlook other associated injuries. An early repair and restoration of blood perfusion as well as liberal use of heparin play important role to achieve acceptable outcomes.

Keywords

• Popliteal artery injury
• Penetrating injury