Iatrogenic Neurovascular Entrapment Injuries Caused by Reduction and Intramedullary Fixation of Fractures of the Lower Limb

Abstract

Background:

Damage to the main neurovascular trunk in the lower limb due to trauma has also been described in the literature. Little attention, however, has been directed toward the quantitative assessment of iatrogenic injury to peripheral neurovascular structures caused by the treatment of open fractures in the lower limb. Obtaining an angiography of the lower limb early in the course of treatment of such injuries is necessary.

Methods:

We performed a retrospective analysis of 253 patients with open fractures. We divided into them into two groups, treated either with an intramedullary (A) or an extramedullary (B) approach. We furthermore noted whether a free tissue transfer was necessary in either group. Particular attention was directed to iatrogenic neurovascular injuries caused by reduction and intramedullary fixation.

Results:

In group A, we found two cases of entrapment of the anterior tibial artery and its concomitant veins, and the deep peroneal nerve. In group B, we recorded four cases of iatrogenic injuries to the common peroneal nerve. Free tissue transfer was performed in 102 cases, 4 of which were emergency free flaps.

Conclusion:

We wish to stress that ascertaining the anatomy and patency of the vascular anatomy of the injured limb early during the primary assessment of the patient, either by palpation, portable Doppler flowmeter, duplex sonography, or angiography before, and preferably also after, reduction and intramedullary nailing of the fracture is in our view mandatory, before any treatment of the fracture is envisioned.