Extrinsic compression of the external iliac artery following internal fixation of an acetabular fracture

Acetabular and pelvic fracture repair complicated by phlegmasia cerulea dolens: A report of limb salvage with open thrombectomy and modified Palma procedure

A 57-year-old man presented after a fall, which resulted in acetabular and pelvic fractures. He underwent fracture fixation, which was complicated by iliac vein occlusion, leading to phlegmasia cerulea dolens. He underwent lower extremity surgical venous thrombectomy, contralateral iliac vein stent placement, and modified Palma procedure with an expanded polytetrafluoroethylene venous crossover bypass and arteriovenous fistula creation. His postoperative course was unremarkable and he regained full function of the extremity without significant stasis complications. The bypass and stent remain patent 3 years postoperatively. Although iliac vein injury during acetabular fracture repair is rare, prompt recognition and intervention prevent limb loss.

Extrinsic compression of the right external iliac artery secondary to iliac vein stenting

Symptomatic extrinsic compression of the external iliac artery (EIA) is a rare complication of surgical intervention. Previous cases of EIA compression have presented in the postoperative period after orthopedic surgery or vascular stenting. We report a case of right EIA compression postvenous stenting causing acute limb ischemia.

[Mechanism and surgical treatment of acetabular roof column fractures with external iliac arterial injury: analysis of 4 cases]

Pelvic arterial injuries caused by pelvic or acetabular fractures are rare (15%-20%), and the complication by external iliac artery (EIA) injuries is even rarer, which can result in a mortality rate as high as 75%-83%. The mechanism of major artery damage caused by pelvic or acetabular fractures remains unclear. We report our experience with surgical treatment of 4 patients with acetabular roof column fracture and EIA injury. All the 4 patients underwent injury control resuscitation and surgery after admission. One patient died of multiple organ dysfunction syndrome (MODS), and the other 3 patients recovered smoothly. In these cases, as we presume, the occurrence of acetabular roof column fracture caused the EIA, which was connected to the iliopsoas muscle through soft tissues such as the iliac fascia, to be pulled into the fracture space along with the iliopsoas muscle and was cut directly by the fracture end; the EIA may also be punctured during transport and fracture reduction. Although acetabular roof column fractures with EIA injuries rarely occur, the consequences can be fatal. In such cases, clinicians should be highly vigilant about the possibility of large vessel injuries, and its early detection using threedimensional vascular reconstruction based on CT vessels or arterial interventional angiography can be critical for implementation of early treatment to save the limbs.

External iliac artery thrombosis following open reduction of acetabular fracture: a case report and literature review

BACKGROUND

Postoperative thrombosis of the external iliac artery (EIA) following open reduction and internal fixation for acetabular fracture is extremely rare.

PURPOSE

To report a patient with EIA thrombosis following open reduction and internal fixation using the modified ilioinguinal approach for acetabular fractures.

STUDY DESIGN

This is a case report of a 69-year-old male with a left acetabular fracture who was treated surgically.

METHODS

A 69-year-old male presented with left hip pain after a 1.5-m fall. Radiographs revealed left acetabular anterior wall and posterior hemitransverse fractures with dome impaction. Computed tomography (CT) showed atherosclerotic changes in many arteries. Open reduction and internal fixation were performed using the modified ilioinguinal approach. Adhesion around the external iliac vessels was severe, and the external iliac vein (EIV) ruptured during exposure. After EIV repair, anatomical reduction was achieved and the fracture was fixed using a reconstruction plate. Nine hours after surgery, the left lower limb showed acute ischemic symptoms. Contrast-enhanced CT indicated complete occlusion of the left EIA. The patient was immediately taken for a thrombectomy via EIA cut-down using a Fogarty catheter. Postoperatively, he had palpable dorsalis pedis and posterior tibial pulses; however, post-reperfusion compartment syndrome developed. Fasciotomy of the left leg was performed.

RESULTS

At the 2-year and 4-month follow-up, he was pain-free in his hip and leg. Although he was walking with a cane, activity was limited due to a mild foot drop.

CONCLUSIONS

It is very important for surgeons to consider EIA thrombosis as a potential complication following open reduction and internal fixation. In this case, EIA thrombosis could be explained by preoperative atherosclerotic changes and intraoperative vascular handling procedures. Preoperative screening and management, and meticulous surgical procedures are necessary for patients with a high risk of thrombosis.

Accuracy and safety of percutaneous periacetabular screw insertion using screw view model of navigation in acetabular fracture: A case report

RATIONALE

The purpose of this study was to estimate the efficacy and safety of percutaneous periacetabular screw (PPS) insertion assisted by screw view model of navigation (SVMN) to treat fracture of acetabulum.

PATIENT CONCERNS

A 61-year-old male patient was injured in a motorcycle accident, which caused pain, swelling, deformity and limited mobility on his right hip.

DIAGNOSES

He was diagnosed with fracture of acetabulum.

INTERVENTIONS

We used PPS insertion assisted by SVMN to treat fracture of acetabulum in this patient.

OUTCOMES

The follow up lasted 24 months. Totally 2 screws were inserted into anterior and posterior column of acetabulum respectively and both of them displayed grade 0. Compared with the preoperative gap and step of fracture displacement, the postoperative ones were significantly reduced. It took 11.7 minutes for designing the screws, 6.7 minutes for implanting the guide wire, and 45.5 minutes for placing the screws. Intraoperative blood loss was 29 mL and total fluoroscopic time was 4.1 minutes. No clinical complications such as nerve vascular injury, infection and screw loosening were found after the operation.

LESSONS

The study indicated that SVMN is favorable to the PPS insertion for acetabular fracture. Our lesson is that the relative position between the acetabular and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.

Sonography of orthopedic hardware impingement of the extremities

The purpose of this pictorial essay is to describe the sonographic appearance of orthopedic hardware impingement of the extremities. Sonography is not limited by metallic artifacts, can show the orthopedic hardware, and can be used to assess damage of adjacent soft tissues, including tendons, synovial bursas, muscles, nerves, and vessels. Its dynamic capabilities permit assessment of orthopedic hardware impingement present only in certain joint positions, during muscle contractions, and during tendon movements. Local pain elicited with application of pressure from the transducer confirms the diagnosis. Sonographically guided injections of steroid-anesthetic mixtures have both diagnostic and therapeutic effects.

Intermittent claudication caused by a giant atypical lipoma of the thigh

The main cause of intermittent claudication in lower limbs is peripheral vascular disease. Less commonly, the etiology can be extrinsic to vascular structures, as in the cases of tumors that, due to their rapid growth, can reduce the blood supply and produce intermittent claudication during gait. We report the case of a 49-year-old patient with intermittent claudication in the left lower limb, reporting the presence of a tumor in the inner side of the left thigh with rapid growth. Doppler and angiography magnetic resonance imaging examinations demonstrated the presence of an adipose tumor that was producing deep and superficial extrinsic compression of the femoral arteries.