Zeitschrift für Trauma und Behandlung

The Case of a Job Well Done?

Abstract

Asaf Acker, Amir korngreen, Bloom Shlomo, Shelef Ilan, Perry Zvi and Atar Dan

Minimal invasive techniques for fracture repair are becoming more prevalent as increased experience is gained by orthopedic trauma surgeons worldwide, with minimal invasive plate osteosynthesis (MIPO) surgery being a popular one. In the current case report we describe a rare complication of fracture management, where anterior tibial artery occlusion occurred as a result of direct pressure by an LCP 4.5 mm plate inserted via MIPO technique. The case involves a 41-year-old man was brought to the emergency trauma room after sustaining a gunshot injury to the Lt tibia. the surgical team preformed a closed reduction and internal fixation with LCP 4.5 mm (Synthes) plate and screws through a lateral incision in a minimal invasive technique. In the recovery room, thirty minutes after the end of the first surgery, the patient developed acute leg ischemia and was rushed back into the operating room. After lateral fasciotomy and exploration, the tibial peroneal tract was found to be completely torn, with no pulse of the tibialis anterior artery, Thrombectomy was performed and a graft used. Even though, the ischemia continued and Selective angiography demonstrated the tibialis anterior pressed between the tibia and the plate with complete obstruction. The plate was immediately removed and the artery was reconstructed using the saphenous vein from the uninjured leg. Even though arterial complications after fracture management are rare, they do happen and one should keep them in mind and be vigilant for them, thus if they do occur, one can attend to them early.