Entrapment of the anterior tibial artery in a distal tibial fracture after intramedullary nailing

• Published in: Der Unfallchirurg 2006-02, Vol.109 (2), p.156-159
• Main Authors: Labler, L, Wedler, V, Mica, L, Trentz, O
• Format: Article
• Language: ger
• Subjects: Aged; Anastomosis, Surgical; Angiography; Ankle Injuries - diagnostic imaging; Ankle Injuries - surgery; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Compartment Syndromes - diagnostic imaging; Compartment Syndromes - surgery; Debridement; Foot Injuries - diagnostic imaging; Foot Injuries - surgery; Forefoot, Human - blood supply; Forefoot, Human - injuries; Forefoot, Human - surgery; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Male; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Reoperation; Surgical Flaps - blood supply; Tibial Arteries - injuries; Tibial Fractures - diagnostic imaging; Tibial Fractures - surgery
• ISSN: 0177-5537
• DOI: 10.1007/s00113-005-1033-x

We present a patient with a closed displaced distal tibia fracture with entrapment of the anterior tibial vessels in the fracture after tibial nailing. This complication was initially not recognised. After several debridements of the forefoot on the same side due to open metatarsal fractures and severe soft tissue injury, a free latissimus dorsi flap was used for covering the dorsum pedis. Preoperative angiography showed occlusion of the anterior tibial artery at the fracture line which was interpreted as a secondary occlusion due to an intima lesion of the vessel after injury. The entrapment in the fracture line was recognised intra-operatively during the preparation of the anterior tibial vessel.