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ID 57799
Author
Yamamoto, Norio Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital
Noda, Tomoyuki Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID
Saito, Taichi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
Uehara, Takenori Department of Emergency Healthcare and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
Shimamura, Yasunori Department of Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID
Ozaki, Toshifumi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Kaken ID publons researchmap
Abstract
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.
Keywords
Acetabular fracture
External iliac artery
External iliac vein
Ilioinguinal approach
Occlusion
Thrombosis
Note
This fulltext will be available in Oct12 2020
Published Date
2019-10-23
Publication Title
Archives of Orthopaedic and Trauma Surgery
Publisher
Springer
ISSN
0936-8051
NCID
AA10738765
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
File Version
author
PubMed ID
DOI
Web of Science KeyUT
Related Url
isVersionOf https://doi.org/10.1007/s00402-019-03288-3
License
https://creativecommons.org/licenses/by-nc-nd/4.0/
Citation
Yamamoto, N., Noda, T., Saito, T. et al. External iliac artery thrombosis following open reduction of acetabular fracture: a case report and literature review. Arch Orthop Trauma Surg (2019) doi:10.1007/s00402-019-03288-3