Clin Orthop Surg.  2016 Mar;8(1):115-118. 10.4055/cios.2016.8.1.115.

Compartment Syndrome Following Arthroscopic Removal of a Bullet in the Knee Joint after a Low-Velocity Gunshot Injury

• Keskinbora M
• Yalcin S
• Oltulu I
• Erdil ME
• Ormeci T

• KMID: 2363955
• DOI: http://doi.org/10.4055/cios.2016.8.1.115

Abstract

Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.

Keyword

Bullet; Knee; Joint; Arthroscopy

MeSH Terms

Adult
Arthroscopy/*adverse effects
*Compartment Syndromes
Humans
Knee Injuries/*surgery
Male
*Postoperative Complications
Turkey
*Wounds, Gunshot

Figure

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  Fig. 1 Localization of the bullet on preoperative anteroposterior (A) and sagittal (B) oblique radiographs.

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  Fig. 2 Preoperative axial (A) and sagittal (B) multiplanar reconstruction noncontrast computed tomography images.

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  Fig. 3 Arthroscopic view of the bullet in the knee joint in relation to the intercondylar notch.

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  Fig. 4 Postoperative axial (A) and sagittal (B) PD SPAIR, coronal T1 turbo spin echo (C), and coronal PD SPAIR (D) images. PD: proton density, SPAIR: spectral adiabatic inversion recovery.

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