Vascular and Neurological Injury in Children With Posterior Traumatic Knee Dislocation

The American Surgeon ◽

10.1177/00031348211050589 ◽

2021 ◽

pp. 000313482110505

Author(s):

Raphael H. Parrado ◽

David M. Notrica

Keyword(s):

Vascular Injury ◽

Saphenous Vein Graft ◽

Knee Dislocation ◽

Neurological Injury ◽

Data Set ◽

National Trauma ◽

American College Of Surgeons ◽

Icd Codes ◽

Posterior Knee ◽

Knee Dislocations

Posterior knee dislocations (PKD) in children are uncommon but may be associated with vascular injury. The purpose of this study is to characterize the frequency of vascular injury in PKD as well as define patient characteristic, procedures, types of treating hospitals, and clinical outcomes. This study utilized the National Trauma Data Set (NTDS) from the American College of Surgeons on years 2015 and 2016. All demographic and clinical data on pediatric patients (≤18 years) with the ICD codes for PKD were obtained. 44 PKD were identified. The median age was 17 years [IQR 15,18], 70% male; 49% white. The mean body mass index was 29.6 [IQR 23-38]. We found that vascular injury was present in 16 patients (36%); 14 (30%) underwent repair (eight with saphenous vein graft) and fasciotomies in eight patients. Nerve injury was present in five patients (11%). Lower extremity amputation was performed in three patients (7%).

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Knee dislocation and associated injuries: an analysis of the American College of Surgeons National Trauma Data Bank

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05712-y ◽

2019 ◽

Vol 28 (2) ◽

pp. 568-575 ◽

Cited By ~ 3

Author(s):

Majid Chowdhry ◽

Daniel Burchette ◽

Danny Whelan ◽

Avery Nathens ◽

Paul Marks ◽

...

Keyword(s):

Knee Dislocation ◽

Data Bank ◽

Associated Injuries ◽

National Trauma ◽

National Trauma Data Bank ◽

American College Of Surgeons

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An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set

The American Surgeon ◽

10.1177/00031348211011099 ◽

2021 ◽

pp. 000313482110110

Author(s):

Adel Elkbuli ◽

Scott Rowe ◽

Shahm Raslan ◽

Aleeza Ali ◽

Brad Boserup ◽

...

Keyword(s):

Trauma Patient ◽

Patient Outcomes ◽

Motor Vehicle ◽

Trauma Patients ◽

Data Set ◽

Program Participant ◽

Quality Program ◽

Field Triage ◽

American College Of Surgeons ◽

Mode Of Transportation

Background Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. Methods A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. Results Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. Conclusion DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.

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Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.067 ◽

2013 ◽

Vol 57 (5) ◽

pp. 1196-1203 ◽

Cited By ~ 40

Author(s):

Andrew G. Georgiadis ◽

Farah H. Mohammad ◽

Kristin T. Mizerik ◽

Timothy J. Nypaver ◽

Alexander D. Shepard

Keyword(s):

Vascular Injury ◽

Knee Dislocation ◽

High Energy ◽

Low Energy ◽

Morbidly Obese ◽

High Energy Trauma

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Utility of intraoperative electromyography in placing C7 pedicle screws

Journal of Neurosurgery Spine ◽

10.3171/2019.11.spine191120 ◽

2020 ◽

Vol 32 (6) ◽

pp. 891-899 ◽

Cited By ~ 1

Author(s):

Jonathan J. Rasouli ◽

Brooke T. Kennamer ◽

Frank M. Moore ◽

Alfred Steinberger ◽

Kevin C. Yao ◽

...

Keyword(s):

Cervical Spine ◽

Pedicle Screw ◽

Thoracolumbar Spine ◽

Pedicle Screws ◽

Neurological Injury ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Data Set ◽

Subaxial Cervical Spine ◽

Increased Risk

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

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Limb salvage and outcomes among patients with traumatic popliteal vascular injury: An analysis of the National Trauma Data Bank

Journal of Vascular Surgery ◽

10.1016/j.jvs.2006.02.052 ◽

2006 ◽

Vol 44 (1) ◽

pp. 94-100 ◽

Cited By ~ 133

Author(s):

Philip S. Mullenix ◽

Scott R. Steele ◽

Charles A. Andersen ◽

Benjamin W. Starnes ◽

Ali Salim ◽

...

Keyword(s):

Limb Salvage ◽

Vascular Injury ◽

Data Bank ◽

National Trauma ◽

National Trauma Data Bank

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Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Neurosurgical FOCUS ◽

10.3171/2015.9.focus15383 ◽

2015 ◽

Vol 39 (6) ◽

pp. E11 ◽

Cited By ~ 34

Author(s):

Yimo Lin ◽

I-Wen Pan ◽

Rory R. Mayer ◽

Sandi Lam

Keyword(s):

Quality Improvement ◽

Blood Transfusion ◽

Retrospective Chart Review ◽

Administrative Claims ◽

Data Sets ◽

Cardiac Events ◽

Improvement Program ◽

Data Set ◽

American College Of Surgeons ◽

Inpatient Database

OBJECT Research conducted using large administrative data sets has increased in recent decades, but reports on the fidelity and reliability of such data have been mixed. The goal of this project was to compare data from a large, administrative claims data set with a quality improvement registry in order to ascertain similarities and differences in content. METHODS Data on children younger than 12 months with nonsyndromic craniosynostosis who underwent surgery in 2012 were queried in both the Kids’ Inpatient Database (KID) and the American College of Surgeons Pediatric National Surgical Quality Improvement Program (Peds NSQIP). Data from published clinical craniosynostosis surgery series are reported for comparison. RESULTS Among patients younger than 12 months of age, a total of 1765 admissions were identified in KID and 391 in Peds NSQIP in 2012. Only nonsyndromic patients were included. The mean length of stay was 3.2 days in KID and 4 days in Peds NSQIP. The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, 0%-0.8% in the literature) were low and similar between the 2 data sets. The reported rates of blood transfusion (36% in KID, 64% in Peds NSQIP, and 1.7%-100% in the literature) varied between the 2 data sets. CONCLUSIONS Both the KID and Peds NSQIP databases provide large samples of surgical patients, with more cases reported in KID. The rates of complications studied were similar between the 2 data sets, with the exception of blood transfusion events where the retrospective chart review process of Peds NSQIP captured almost double the rate reported in KID.

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Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment

The American Surgeon ◽

10.1177/00031348211038556 ◽

2021 ◽

pp. 000313482110385

Author(s):

David P Stonko ◽

Faris K. Azar ◽

Richard D. Betzold ◽

Jonathan J. Morrison ◽

Ryan B. Fransman ◽

...

Keyword(s):

Inferior Vena Cava ◽

Vascular Injury ◽

Inferior Vena ◽

Management Strategies ◽

Vena Cava ◽

Multicenter Trial ◽

Data Set ◽

Injury Treatment ◽

Contemporary Management ◽

Injury Burden

Introduction Injuries to the inferior vena cava (IVC), while uncommon, have a high mortality despite modern advances. The goal of this study is to describe the diagnosis and management in the largest available prospective data set of vascular injuries across anatomic levels of IVC injury. Methods The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from November 2013 to January 2019. Demographics, diagnostic modalities, injury patterns, and management strategies were recorded and analyzed. Comparisons between anatomic levels were made using non-parametric Wilcoxon rank-sum statistics. Results 140 patients from 19 institutions were identified; median age was 30 years old (IQR 23-41), 75% were male, and 62% had penetrating mechanism. The suprarenal IVC group was associated with blunt mechanism (53% vs 32%, P = .02), had lower admission systolic blood pressure, pH, Glasgow Coma Scale (GCS), and higher ISS and thorax and abdomen AIS than the infrarenal injury group. Injuries were managed with open repair (70%) and ligation (30% overall; infrarenal 37% vs suprarenal 13%, P = .01). Endovascular therapy was used in 2% of cases. Overall mortality was 42% (infrarenal 33% vs suprarenal 66%, P<.001). Among survivors, there was no difference in first 24-hour PRBC transfusion requirement, or hospital or ICU length of stay. Conclusions Current PROOVIT registry data demonstrate continued use of ligation extending to the suprarenal IVC, limited adoption of endovascular management, and no dramatic increase in overall survival compared to previously published studies. Survival is likely related to IVC injury location and total injury burden.

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The Irreducible Knee Dislocation

The Journal of Knee Surgery ◽

10.1055/s-0039-1698749 ◽

2019 ◽

Vol 33 (04) ◽

pp. 328-334

Author(s):

Shahbaz S. Malik ◽

Peter B. MacDonald

Keyword(s):

Soft Tissues ◽

Case Reports ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Knee Dislocation ◽

Small Subset ◽

Ligament Injuries ◽

Small Series ◽

Anterior Cruciate ◽

Knee Dislocations

AbstractIrreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is posterolateral, which can be challenging to diagnose both clinically and on plain radiographs. Vascular injury is uncommon and closed reduction is seldom possible due to medial femoral condyle buttonholing through soft tissues requiring open or arthroscopic reduction. Ligament injuries mostly include medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Literature has numerous case reports with a couple of small series giving short- to mid-term outcomes of posterolateral knee dislocations. There is, however, no consensus on management of ligament injuries with case reports showing good outcomes in early or delayed ligament reconstruction. This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations.

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Initial Assessment and Implications for Surgery: The Missed Diagnosis of Irreducible Knee Dislocation

The Journal of Knee Surgery ◽

10.1055/s-0037-1602135 ◽

2017 ◽

Vol 31 (03) ◽

pp. 254-263 ◽

Cited By ~ 5

Author(s):

Honggang Xu ◽

Jun Tu ◽

Bin Xu ◽

Ruipeng Guo

Keyword(s):

Open Reduction ◽

Cruciate Ligament ◽

Case Series ◽

Knee Dislocation ◽

Initial Assessment ◽

Retrospective Case ◽

Case Series Study ◽

Status Assessment ◽

Low Incidence ◽

Knee Dislocations

AbstractIrreducible knee dislocation is a rare but devastating orthopedic emergency. Limited discussion about its characteristics has been undertaken due to its low incidence. The purpose of this study was to present a series of irreducible dislocated knees and cumulatively reviewed all existing publications in this filed. A retrospective case series study was undertaken in patients with irreducible knee dislocation. Patients' data were carefully collected and presented. Historical cases of irreducible knee dislocation in published papers were reviewed, and their diagnosis, treatment, and prognosis were summarized. Six patients with six irreducible knee dislocations were enrolled with an average age of 51.2 ± 9.7 years. Patterns of injuries were classified into KD-III M (three cases), KD-IV (two cases), and KD-V (one case). Dimple sign was presented in all cases on both physical examination and MRI. All patients received single-stage arthrotomy together with cruciate ligament reconstruction acutely. In cumulative literature review, 34 papers with 45 irreducible knee dislocations were included. KD-III M was the most familiar type of ligamentous injury (75.0%). Dimple sign was recorded in 83.7% occasions and the most frequent two trapped structures were medial retinaculum (31.8%) and MCL (43.1%). Open reduction was conducted in all cases to reduce the knee, and the prognosis of 88.0% cases was considered to be acceptable after different staged surgery. The “dimple” sign is pathognomonic but not necessary for diagnosis of irreducible knee dislocations. The general consensus for treatment is immediate neurovascular status assessment and acute open reduction.

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