Popliteal Artery Injury: A Limb-Threatening Complication of Knee Fracture/Dislocation

The popliteal artery courses through the popliteal fossa, tethered by fibrous tissue—making it vulnerable in knee trauma.

Mechanism

• Knee dislocation (multi-ligament) → artery stretched/torn.
• Tibial plateau/femoral condyle fractures → bony fragments lacerate vessel.
• Incidence: 10–40% with dislocation; 1–5% with fractures.

Hard Signs of Vascular Injury (Immediate Surgery)

• Pulsatile bleeding
• Expanding hematoma
• Absent distal pulses (dorsalis pedis, posterior tibial)
• Bruit/thrill over wound
• Palpable thrill

Soft Signs (Require Investigation)

• History of moderate hemorrhage
• Proximity of fracture to vessel
• Neurologic deficit (peroneal nerve often co-injured)
• ABI <0.9

Diagnostic Workup

• CT angiography (gold standard) — fast, non-invasive.
• Duplex ultrasound — bedside, operator-dependent.
• Conventional angiography — if intervention planned.

Management

• Emergent exploration + repair (interposition graft, usually saphenous vein).
• Fasciotomy often needed (reperfusion edema → compartment syndrome).
• Vascular surgery + ortho coordination.

Outcome

Delayed diagnosis (>6–8 hrs ischemia) → ↑ amputation rate (up to 30–50%). High index of suspicion saves limbs.