Open, arterial injuries linked with early complications among patients with knee dislocations

SAN DIEGO — Although few patients with knee dislocation had functional instability necessitating late cruciate reconstruction, investigators discovered early complications were more likely to occur in patients with either open injuries or arterial injuries.

“We identified complications in 39% of our patients, and our goal was to determine risk factors for complications and poor outcomes,” Nicholas Scarcella, BS, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “Infections and other complications were most often associated with open injuries and arterial injuries. Older age and obesity were associated with post-traumatic arthrosis, indicating an opportunity to counsel patients accordingly.”

Scarcella and colleagues identified 116 patients (64% men) with knee dislocations. Of these, 74% had high-energy mechanisms and 33% had open knee dislocations. The researchers found no functional instability among patients at a mean follow-up of 18 months and a mean arc of knee motion of 115° at 1 year. Scarcella noted a 39% complication rate, with 72 complications occurring in 45 patients.

“Complications were more common in patients with a higher [Injury Severity Score] ISS score, an open injury or an arterial injury,” Scarcella said. “The most common complication was wound infection, occurring in 20% of patients.”

Patients with an open injury or arterial injury also were significantly more likely to develop a wound infection. Patients with a wound infection were more likely to develop heterotopic ossification and had worse range of motion, according to the researchers.

Scarcella added that a significant decrease in passive range of motion at 6 months and 12 months was found among patients with an ISS of greater than or equal to 20. Significant independent predictors for the development of post-traumatic arthrosis included BMI greater than 35 and increased age.

“Forty-two patients completed a muscular function assessment [MFA] survey, and surveys were obtained after a minimum of 12-months follow-up,” Scarcella said. “The median MFA score of the entire patient population was 38.6, demonstrating a high level of impairment compared to the uninjured reference population.” — by Casey Tingle

Reference:

Scarcella N, et al. Paper #39. Presented at: Orthopaedic Trauma Association Annual Meeting. Oct. 7-10, 2015; San Diego.

Disclosure: Scarcella reports no relevant financial disclosures.