Prevalence of vascular injury in patients with orthopaedic trauma on the knee at Chris Hani Baragwanath Academic Hospital

Background

Vascular injuries are frequently observed in cases of musculoskeletal trauma affecting the knee. The evidenced-based protocols are underutilised. This often leads to the overuse of Computed Tomography Angiogram (CTA). The purpose of this study was to assess the prevalence of arterial damage among individuals with knee musculoskeletal injuries.

Methods

All individuals with distal femur fracture, knee instability, and proximal tibia fractures were obtained from the picture archiving and communication system (PACS). These individuals were either being investigated for vascular injury or done radiological investigations for orthopaedic surgical planning. The data were obtained from 01 June 2017 to 30 June 2022. The reports from the CTA were examined to identify instances of vascular damage.

Results

Five hundred and fifteen patients were collected from PACS. The overall prevalence of vascular damage among individuals with musculoskeletal knee injuries was found to be 9.7 %. The confidence interval was 7.1‒12.3 %. There were no discernible variations in the prevalence between males and females. There was a positive correlation between the age of the patient and the prevalence of vascular injury. This suggests that younger people have a higher prevalence. Penetrating injuries and knee dislocation had higher rates of vascular injury and the rates were 17.8% and 15.4%, respectively. Patients with soft signs of vascular injury had a low rate of 10.8 %. Only one in 10 patients with soft signs vascular injury had CTA confirming vascular injury. Therefore, using soft signs of vascular injury as indication for CTA was found not to be cost effective.

Conclusion

The prevalence of vascular injury at our hospital, a tertiary hospital in Soweto is within the global range that is reported in the literature. Further screening patients with soft signs of vascular.