Popliteal artery transection associated with a minimally displaced tibial plateau fracture: a case report and review of the literature

Abstract

Background: Poplital artery transection injury is potentially catastrophic, or even life-threatening. Severe traumas, including open fracture, gunshot, stabs, and knee dislocation and complex fracture of proximal tibia or distal femur, are the common causes of high rate of amputation due to popliteal artery trauma. No report mentions vascular injury associated with minimally displaced tibial plateau fracture in adult. Case presentation: A 30-year-old male presented with popliteal artery transection injury associated with minimally displaced tibial plateau fracture. He presented to emergency department, 6 h after fall from ground into a 1-m height hole. Physical examination suggested acute ischemia, with signs of paleness, coldness, anesthesia, hemorrhagic bullae below the right knee level. There was severe swelling and ecchymosis in popliteal fossa and around the leg with significant calf tenderness and pedal edema. Tibialis posterior, dorsalis pedis, and popliteal arterial pulses were not palpable. Radiograph suggested minimally displaced tibial plateau fracture with no evidence of knee dislocation. The patient was taken up for emergency surgery after consultation with vascular surgeon. During the closed reduction external fixation and compartment decompression, popliteal artery trunk was found transected and end-to-end repair was performed. During the post-operational period, no complication was developed and the patient was followed-up for 1 year. At the one-year follow-up, he acquired good stability of his right knee with full range of motion. Conclusion: Significant swelling and ecchymosis should alert the surgeons to the possibility of vascular injury in knee joint injury, even if there is no fracture or dislocation, or fracture is minimally displaced.

Complete posterior dislocation of fractured lateral condyle of tibia with disruption of proximal tibiofibular joint: Technical note

“…A high index of suspicion for vascular injury should be considered in such cases. 3 In so far reported fracture dislocations of knee, the subluxated or dislocated articular segment of tibial plateau is in direct continuity with rest of tibia. They could be reduced to appropriate position by manoeuvring the remaining tibia.…”

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection—The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report

“…We report the case of an 18-year-old female patient who suffered an extensive leg degloving with a distal tibia and fibula fracture and a popliteal artery transection. This is a typical and educational case that demonstrates the importance of the rapid diagnosis and multidisciplinary team approach to decrease the period of ischemia and the rate of amputation [1,4]. A limb ischemia greater than 6 h results in severe necrosis and amputation in up to 30% of patients [3,9].…”

“…Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss [1,3]. Furthermore, severe local infection, which is critical in the presence of major soft tissue trauma or open fractures, has been shown to jeopardize the outcome [1,4]. Rapid diagnosis and prompt surgery decrease the period of ischemia and the rate of amputation; thus, a multidisciplinary team approach has been suggested as a key factor for limb salvage [1,4].…”

“…Furthermore, severe local infection, which is critical in the presence of major soft tissue trauma or open fractures, has been shown to jeopardize the outcome [1,4]. Rapid diagnosis and prompt surgery decrease the period of ischemia and the rate of amputation; thus, a multidisciplinary team approach has been suggested as a key factor for limb salvage [1,4]. Revascularization, either including temporary vascular shunting or not, and protection, preferably using external fixation devices for bone stabilization, have been recommended in these cases [1].…”

A New Three‐Dimensional Classification of Proximal Tibiofibular Fractures: A Multicenter Study

“…Tibial plateau fractures (TPFs) are common and complicated injuries around the knee that result from high‐ or low‐energy trauma, and an increasing number of studies are focused on TPF 1 , 2 , 3 , 4 . Even though TPF and proximal fibula fracture are similar in terms of morphology, mechanism of injury, soft tissue damage, diagnosis, classification, treatment, and knee reconstruction, it has been recognized that the importance of fibular fractures helped us to treat tibial fractures easily 5 .…”