The Utility of Physical Examination in Proximity Penetrating Extremity Trauma

Gonzalez, Richard P.; Falimirski, Marke E.
August 1999
American Surgeon;Aug1999, Vol. 65 Issue 8, p784
Academic Journal
This study assessed the efficacy of physical examination as a screening modality for the diagnosis of surgically significant arterial injury in proximity penetrating extremity trauma (PPET). All cases of PPET were assessed and admitted per established protocol over a 30-month period from January 1, 1993, to June 30, 1995. No patients were excluded if other body regions were also injured. Landmarks defining upper extremity injuries were the deltopectoral groove to the wrist and for lower extremities from the inguinal ligament to the ankle. Patients admitted with PPET fell into one of three categories: 1) no hard signs of vascular injury present--admitted for 24-hour observation; 2) presence of at least one hard sign of vascular injury--taken immediately to the operating room; 3) positive sign of arterial injury that requires angiography (i.e., diminished but appreciable pulse by physical examination or doppler, large nonexpanding hematoma, bilateral pulse deficit, no appreciable pulse with unreconstructable trajectory). Four hundred six patients with 489 injured extremities secondary to PPET were admitted over a 30-month period. Sixty-two extremities suffered multiple injuries. Of the extremities injured, 83 per cent were secondary to gunshot wounds, 12 per cent were attributed to stabs/lacerations, and 5 per cent were due to shotgun injuries. Four hundred twenty-one extremities with PPET fell into Group 1. There were four missed injuries (specificity, 99%) in this group (one ulnar artery, one radial artery, one posterior tibial artery, and one anterior tibial artery). Two of these injuries were considered surgically significant. None of the patients suffered limb or functional loss as a consequence of their missed arterial injury. Thirty-nine extremities were entered into Group 2, with two patients found to have no arterial injury. Twenty-nine extremities were placed into Group 3 with 10 (35%) found to have surgically significant injury on angiogram. The overall...


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