Physeal separation leading to proximal subluxation and popliteal artery thrombosis

• Published in: BMJ case reports 2022-07, Vol.15 (7), p.e251311
• Main Authors: Parija, Debasish, Jain, Mantu, Sathia, Siddhartha, Sahoo, Auroshish
• Format: Article
• Language: English
• Subjects: Blood clots; Case reports; Closed reduction; Compartment syndrome; Fractures; Humans; Injuries; Joint Dislocations; Knee; Medical imaging; Pediatrics; Peripheral Arterial Disease; Popliteal Artery - diagnostic imaging; Surgeons; Teenagers; Thrombosis; Thrombosis - complications; Thrombosis - diagnostic imaging; Trauma; Veins & arteries
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2022-251311

Of these, only 5% have popliteal artery injury.1 Injury to the popliteal artery can be a limb-threatening condition because of poor collateral circulation.2 However, the incidence of popliteal artery injury in a knee dislocation case is around 1.6%–30%.3 A teenage boy presented to our emergency department with a history of injury to his right knee 12 hours earlier, following a road traffic accident. Physeal injuries (PIs) are rare in the proximal tibia accounting for only 1% of all PIs.1 The mechanism is usually a hyperextension injury around the knee joint with or without valgus force, which causes a posterior displacement of the tibial metaphysis with physeal separation.4 SH type II is the most common type of hyperextension injury, as was our case.5 Seven to ten per cent of these PIs are associated with a vascular compromise.6 The vascular insufficiency could arise due to either direct pressure on the vessel due to displaced fracture fragment, tight compartment (compartment syndrome), an associated arterial injury or a developing thrombosis. Ligamentous injuries around the knees and traction injuries to the peroneal nerves are also found in these patients.7 Guled et al could salvage the limb, but foot drop persisted as in our case.9 Finally, extended follow-up may be required as PI can cause limb length discrepancy or angular deformities in 25% of cases, necessitating a follow-up to skeletal maturity.15 16 Learning points Physeal injury of the proximal tibia associated with vascular injury is a rare condition.