Anesthesia & Clinical Research
Open Access

Abstract

Vascular Injury in Obese Patients after Ultra-Low-Velocity Trauma

Ismael Fuchs, Thomas Allmayer, Franz Schweighofer, Josef Tauss, Manfred Wonisch, Gerald Seinost, Manuela Jaindl and Florian M Kovar

Background: Traumatic Knee Dislocation (KD) is a serious and potentially limb threatening injury, albeit a relatively rare condition. Knee dislocation, defined as a complete disruption of the integrity of the tibia-femoral articulation, is uncommon, representing 0.001% to 0.013% of orthopedic injuries. Male:Female ratio is 4:1, and nearly 10% are caused by ultra-low-velocity dislocations. These injuries have historically been attributed to High Velocity Impacts (HVKD) however more recently they are being noted in Low Velocity Incidents (LVKD), particularly involving morbidly obese people. An increase in LVKD in the morbidly obese from 17%, between 1995-2000 to 53% in 2007-2012 was reported in the literature. Methods: In our case series of two female patients vascular injury occurred after an ultra low velocity trauma in the domestic environment. Case 1 was a 72-year old female, BMI 28 kg/m2, with diabetes mellitus Type II, arterial hypertension, and obesity. Case 2 was a 57-year old female, BMI 44 kg/m2, with diabetes mellitus Type II, psychosis, and obesity. Vascular surgery was performed to maintain blood supply for the injured limb. Results: In one case full weight-bearing was achieved and the other case resulted in an above the knee amputation, due to severe soft tissue damage. Conclusion: Knee dislocation is a rare albeit a serious and potentially limb threatening condition. Expediancy in reducing the acutely dislocated knee is vital to prevent neurovascular damage and potential for compartement syndrome and limb amputation. Based on our observation, the knowledge of potentially serious adverse outcomes in obese patients with ultra-low-velocity trauma and vascular injury should increase our awareness in these patients with knee pain even after marginal trauma. X-rays, and if suspicion is raised, a CT-scan usually leads to a detailed and profound diagnosis, enabling immediate surgical intervention to save the affected limb.