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A complication after internal fixation of fracture

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Q1: What is the investigation and what does it show?

Figure 1 (see p 209) shows contrast angiography of the lower leg. The swelling was consistent with a false aneurysm of the anterior tibial after iatrogenic trauma. The lesion was 30 × 30 mm. Duplex Doppler imaging confirmed the origin and extent of the lesion.

Q2: What clinical symptoms may be associated with this type of lesion?

Clinical symptoms are variable and include pain, swelling, recurrent bleeding, compartment syndrome, and claudication.1 The presentation may be late. The case reported here was diagnosed in the second postoperative week. In other cases, the lesion has presented months or years after surgery.

Q3: How should this lesion be managed and what are the complications?

Repair of traumatic false aneurysms is most commonly by direct ligation or end-to-end anastomosis. In this case urgent surgical exploration was undertaken, the arterial injury was identified, and a primary repair carried out using a 6/0 polypropylene suture. This patient made an uneventful recovery and was discharged home after one week. A complication rate of 6% is described where primary repair is achieved.2 The most important complications are infection, recurrence of pseudoaneurysm, and limb loss.3

The commonest causes of false aneurysm are vascular surgical procedures, vascular interventional radiology procedures,4and penetrating trauma. Iatrogenic orthopaedic trauma has been implicated in the aetiology of false aneurysms in several reports.5

Final diagnosis

False aneurysm of the anterior tibial artery after trauma.