Pedestrian struck by motor vehicle

Abstract

A 30-year-old male is struck by a car while crossing the street. He is brought in by paramedics hemodynamically stable with a blood pressure of 130/70 mmHg, heart rate of 80/min, and a right knee deformity. His airway is intact and breath sounds are equal bilaterally. Abdominal and pelvic exams are unremarkable. There is swelling and an obvious deformity of his right knee. His right foot is pale and cool, with a 6 s capillary refill, whereas the left foot is pink and warm with <2 s capillary refill. Pulse examination reveals normal 2+ pulses in his left femoral, popliteal, dorsalis pedis, and posterior tibial arteries. On the right, there is a 2+ femoral pulse. The popliteal pulse cannot be examined due to pain. The right dorsalis pedis and posterior tibial artery pulses are non-palpable. Sensory and motor function is intact bilaterally. Because of severe knee pain, the right knee cannot be examined. There is no tenderness or deformity in the right thigh or in the tibia or ankle. The right lower extremity ankle-brachial index (ABI) is 0.65, whereas the left is 1.0. Plain films of the right knee are shown below.