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This 40 year old man was the backseat passenger of a car involved in a head-on collision.  He was not wearing a seat belt and was thrown into the front of the car.  His left knee caught one of the seats and when he was found, his left leg was caught between the driver and passenger's seats, while the rest of his body was in the front of the car.  The driver and passenger were belted and were uninjured.  Aside from severe left knee pain and deformity he is stable in the trauma room.  There is no dorsalis pedis or posterior tibial pulse on the left side, either by palpation or Doppler.  

Knee Radiographs in Trauma Room:

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What is your diagnosis ?  

How would you manage this patient in the trauma room ?  

After IV conscious sedation in the trauma room, a closed reduction of the left knee was carried out with return of the dorsalis pedis and posterior tibial pulses.  He was placed in a Waddell-Jones bandage post reduction and referred to one of the sports medicine surgeons for reconstruction.  

Post Reduction Views in Trauma Room:

kd_ap2.jpg (17912 bytes)  kd_lat2.jpg (14887 bytes)  

What are the short term problems with this injury ?  

What are the indications for an angiogram ?  

What is your specific management plan ?

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