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Kvas SP, Jorgensen SF. Pseudoaneurysm of the Dorsalis Pedis Artery Following Open Reduction Internal Fixation of a Second Metatarsal Fracture: A Case Study. J Am Podiatr Med Assoc 2022; 112:20-201. [PMID: 36459069 DOI: 10.7547/20-201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pseudoaneurysms are created by a traumatic or iatrogenic perforation of an artery, resulting in accumulation of blood between the two outermost layers of a blood vessel, the tunica media and tunica adventitia. Pedal artery pseudoaneurysms are an extremely uncommon complication of foot and ankle surgery; therefore, few cases have been reported in the literature. Early diagnosis is important to ensure timely treatment of this condition. Once clinical suspicion has been established, urgent referral to vascular surgery for prompt surgical evaluation is required to prevent potentially harmful sequalae. We present the case of a 70-year-old female who developed a pseudoaneurysm of the dorsalis pedis artery 33 days after undergoing open reduction internal fixation (ORIF) of a second metatarsal fracture. Her treatment included urgent referral to vascular surgery with subsequent surgical repair of the pseudoaneurysm via ligation of the medial dorsal branch of the dorsalis pedis artery. At 10-month follow-up, she denied any pain, sensory deficits, or functional disability and had returned to all preinjury activities with no recurrence of the pseudoaneurysm. Our case study demonstrates early diagnosis and successful treatment of a pseudoaneurysm of the dorsalis pedis artery that developed shorty after ORIF of a second metatarsal fracture.
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Mehta R, Agrawal A, Joshi S, Agashe M, Sinha SK. Unusual Combination of a Fracture Monteggia Equivalent With Post-traumatic Radial Artery Pseudoaneurysm in a Child: A Case Report and Review of Literature. JBJS Case Connect 2020; 10:e1900327. [PMID: 32910600 DOI: 10.2106/jbjs.cc.19.00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a unique case of a combination of forearm fracture and traumatic radial artery pseudoaneurysm in an 8-year-old child. The fracture pattern was a Monteggia equivalent with a mid-diaphyseal ulnar fracture and a radial neck fracture with displacement of the distal radial diaphyseal fracture fragment. The pseudoaneurysm, which probably developed after vigorous manipulation by a bonesetter, thrombosed spontaneously, and the fracture was managed nonoperatively with a good outcome. CONCLUSION Pseudoaneurysm of the radial artery is a rare phenomenon associated with fracture in a child. A history of vigorous manipulation of displaced fracture fragments in the vicinity of a major vessel should raise suspicion of this possible complication.
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Affiliation(s)
- Rujuta Mehta
- 1Department Paediatric Orthopaedics, Bai Jerbai Wadia Children's Hospital, Mumbai, India 2Bai Jerbai Wadia Children's Hospital, Mumbai, India
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Asadollahi S, Holcdorf D, Stella DL, Bucknill A. Identification of the lateral femoral safe zone for drilling during LISS plate fixation of distal femur fractures. Injury 2020; 51:452-456. [PMID: 31882235 DOI: 10.1016/j.injury.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of arterial injury associated with femoral fractures is approximately 1%. Lateral sub-muscular plate fixation is gaining popularity for the management of distal femoral fractures. The objective of this study was to assess the iatrogenic risk to the superficial femoral artery (SFA) during Less Invasive Stabilisation System (LISS) plate fixation of distal femoral fractures by analysing the range of distances and angles between LISS plate screws and the drilling line to the SFA. MATERIALS AND METHODS We identified all patients who underwent LISS plate fixation of distal femoral fractures between 2008 and 2018 in our level-1 trauma centre. Patients who underwent postoperative computed tomography for any reason were eligible for inclusion in the study. Twenty-five patients met the inclusion criteria. The sample comprised 10 male and 15 female patients with a mean age of 55 years. The most common fracture type was a supracondylar femur fracture (56%), followed by an intercondylar fracture (36%). A 13-hole LISS plate was the most common plate length used (44%). A consultant radiologist reviewed all scans to verify the visibility and marking of the SFA. RESULTS The median distance between the screw tip and the SFA was 21 mm (range, 8-65 mm). There was a negative correlation between the LISS plate hole number and the trajectory of drilling (Pearson coefficient: -0.87, p < 0.001). Using a linear regression model, the SFA was more likely to be in the line of drilling when the 6th to 10th holes in the LISS plate were used. CONCLUSION Extra care is needed when drilling into the LISS plate holes from the lateral to the medial direction in order to reduce the risk of iatrogenic injury to the SFA, especially in the high-risk plate zone where the artery can be close to the drilling line.
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Affiliation(s)
- Saeed Asadollahi
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - David Holcdorf
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Damien L Stella
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery (RMH), The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Gao Y, Qiao NN, Zhang YH, Lv X, Liu JY. Application of fracture-sustaining reduction frame in closed reduction of femoral shaft fracture. J Orthop Surg Res 2019; 14:147. [PMID: 31118052 PMCID: PMC6532184 DOI: 10.1186/s13018-019-1145-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives This study aims to explore the clinical efficacy of applying a new reduction brace in the closed reduction of femoral shaft fracture. Methods A total of 18 patients with femoral shaft fracture, who were admitted to the Bone Trauma Surgery, Second Hospital of Shanxi Medical University, from September 2015 to January 2017, were chosen. A novel reduction brace combined with closed reduction intramedullary nail insertion on the traction table adopted for the orthopedic surgery was taken for the fixation. Then, surgical time, bleeding amount, and postoperational fracture healing time were recorded. Results All 18 patients with femoral shaft fracture successfully received closed reduction femoral nail with the application of the novel reduction brace. The follow-up period was 3–18 months, with an average of 12 months, and the femoral shaft fracture was well healed with good recovery of function. Conclusions The design of the closed reduction brace of the femoral shaft fracture was reasonable, simple, and convenient to use and has a short learning curve. Furthermore, it led to little trauma to these patients and fully played the advantages of minimally invasive therapy for femoral fractures.
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Affiliation(s)
- Yan Gao
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China.
| | - Ning-Ning Qiao
- Department of Orthopaedics, 541 General Hospital, Yuncheng, 043801, China
| | - Yong-Hong Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Xin Lv
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Jin-Yuan Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
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Dejean C, Desvergnes M, Bouget P, Rigoard P, Vendeuvre T. Femur Lengthening in a Patient with a Pseudoaneurysm of the Superficial Femoral Artery Treated with Covered Stent. Indian J Orthop 2019; 53:674-676. [PMID: 31488939 PMCID: PMC6699221 DOI: 10.4103/ortho.ijortho_712_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This case report presents a 29-year-old male patient who presented an articular distal femoral fracture sustained in a road traffic accident in Benin. After the different surgical procedures, the patient presents a knee stiffness and a shortening of the left leg of 7 cm. An ablation of osteosynthesis material and a Judet procedure was done. After this surgical intervention, the patient developed pain, pulsatile swelling of the left knee. A false aneurysm of the superficial femoral artery was evidenced, and a percutaneous endovascular procedure was performed. As a result of the important leg-length discrepancy, a femoral lengthening of 6 cm was performed using intramedullary skeletal kinetic distractor nail. We show that a 6 cm femur lengthening in a patient with a femur stent is possible using intramedullary nails provided that orthopedic and vascular surgeons monitor the patient in strict clinical and paraclinical followup conditions.
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Affiliation(s)
- Charles Dejean
- Department of Orthopaedic Surgery, Spine-Neurostimulation Unit University Hospital, Poitiers, France,Address for correspondence: Dr. Charles Dejean, Department of Orthopaedic Surgery, Spine-Neurostimulation Unit University Hospital, Poitiers, France. E-mail:
| | | | - Pierre Bouget
- Department of Orthopaedic Surgery, Spine-Neurostimulation Unit University Hospital, Poitiers, France
| | - Philippe Rigoard
- Department of Neurosurgery, Spine-Neurostimulation Unit Poitiers University Hospital, Poitiers, France
| | - Tanguy Vendeuvre
- Department of Orthopaedic Surgery, Spine-Neurostimulation Unit, Institut P’ CNRS UPR 3346 University Hospital, Poitiers, France
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Raherinantenaina F, Rajaonanahary T, Rakoto Ratsimba H. Management of traumatic arterial pseudoaneurysms as a result of limb trauma. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Raherinantenaina F, Rajaonanahary TMA, Ratsimba HNR. WITHDRAWN: Management of traumatic arterial pseudoaneurysms as a result of limb trauma. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Raherinantenaina F, Rajaonanahary TMA, Rakoto Ratsimba HN. [Femoral artery pseudoaneurysms encountered in orthopedics and traumatology]. ACTA ACUST UNITED AC 2015; 40:376-83. [PMID: 26357938 DOI: 10.1016/j.jmv.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. METHODS A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". RESULTS A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. CONCLUSION Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses.
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Affiliation(s)
- F Raherinantenaina
- Service de chirurgie générale et vasculaire, CHU/HJRA, Tananarive, Madagascar.
| | - T M A Rajaonanahary
- Service de chirurgie générale et vasculaire, CHU/HJRA, Tananarive, Madagascar
| | - H N Rakoto Ratsimba
- Service de chirurgie générale et vasculaire, CHU/HJRA, Tananarive, Madagascar
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Lazarov M, Van der Bracht H, Victor J, Stuyts B. Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur. Orthop Traumatol Surg Res 2014; 100:695-7. [PMID: 25193621 DOI: 10.1016/j.otsr.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 03/15/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Abstract
This case report presents a 38-year-old male patient who developed a false aneurysm of the superficial femoral artery after minimally invasive plate internal fixation of a comminuted articular distal femoral fracture sustained in a motor vehicle accident. Two days after surgery, the patient developed pain, non-pulsatile swelling on the medial side of the knee and anemia. After about six weeks, diagnosis of false aneurysm of the superficial femoral artery was confirmed by duplex ultrasound and computed tomographic angiography. A percutaneous endovascular procedure was performed to treat the false aneurysm without evacuating the blood collection.
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Affiliation(s)
- M Lazarov
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium.
| | - H Van der Bracht
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium
| | - J Victor
- Orthopedic and Traumatology Department, Ghent University, Belgium
| | - B Stuyts
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium
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Hirota R, Emori M, Ito T, Watanabe K, Hirano A, Kamiya T, Terashima Y, Yamashita T. Pseudoaneurysm of the superficial femoral artery after retrograde intramedullary nailing for a supracondylar femoral fracture. Ann R Coll Surg Engl 2014; 96:e1-3. [PMID: 25245711 DOI: 10.1308/003588414x13946184900165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vascular complications of distal femoral fractures are rare but can have disastrous consequences if not recognised and treated promptly. We present the case of a 55-year-old woman who developed a pseudoaneurysm of the superficial femoral artery after osteosynthesis to repair a supracondylar femoral fracture. Eight weeks after surgery, swelling of the right thigh persisted and was accompanied by severe pain. Enhanced computed tomography revealed a pseudoaneurysm in the medial aspect of the affected thigh. Open surgical repair was performed by direct arterial suture. Although the true aetiology of the development of the pseudoaneurysm is unknown, a bony fragment from the reduction manoeuvre may have damaged the adventitia of the superficial femoral artery. In cases of continuous thigh swelling after osteosynthesis to repair a supracondylar femoral fracture, a diagnosis of pseudoaneurysm should be considered and treatment should be initiated immediately.
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Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, Takikawa Municipal Hospital, Takikawa, Hokkaido, Japan
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