4.3 of 89 Ratings
A 32-year-old professional skydiver lands awkwardly during a jump. He presents to the emergency room with bilateral knee injuries. Following successful closed reduction of both extremities, both feet are warm and pulses are present. Bedside doppler assessment is performed and the results are seen in Figure A. What would be the most appropriate next step in treatment?
Long-leg splinting of bilateral lower extremities, monitoring of bilateral pedal pulses for 48 hours
Intravenous dextran administration, repeat doppler evaluation at 6 hourly intervals
Perform CT angiography for bilateral lower extremities
Perform CT angiography for the left lower extremity, monitor right pedal pulses for 48 hours
Surgical exploration of bilateral lower extremities
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A 30-year-old man is the front seat passenger in a motor vehicle accident. He presents with deformity in his knee seen in Figures A and B. Radiographs are seen in Figures C and D. Examination reveals weak foot pulses. After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable and the foot is cool. What is the next step in treatment?
Open reduction through an anteromedial approach, spanning external fixation. If pulses do not return, perform popliteal artery exploration.
Closed reduction in the operating room using a femoral distractor. If pulses do not return, perform on-table angiogram.
Manual in-line skeletal traction using a calcaneal pin in the emergency room, provisional long-leg splinting. If pulses do not return, perform computed tomography angiography in the radiology suite.
Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. If pulses do not return, perform standard angiography in the angiography suite.
Open reduction through a posterior approach, spanning external fixation. If pulses do not return, perform popliteal artery exploration.
Figures A and B are radiographs of a 20-year old male athlete that sustained a high impact tackle during a football game. What percentage of these injuries will present with an associated vascular injury?