Vascular injuries caused by orthopaedic screws. A case report

To describe 3 cases of vascular injuries due to orthopaedic procedures.

Of 242 vascular injuries, 3 were due to orthopaedic screws. The 1st patient presented with a late complication (after 3 years) of an orthopaedic screw placed in close proximity to the axillary artery that with time got eroded and leaked to form a false aneurysm which later caused embolisation to the arm and limb ischaemia. The 2nd and 3rd cases were due acute ischaemia following the orthopaedic procedures. Both were injuries to the popliteal artery, one after a long screw and the other after drilling the tibia. The aneurysm of the 1st case was resected, the screw was removed and a reversed segment of the right long saphenous vein was used to repair the axillary artery. In the 2nd patient, a bypass of the left popliteal artery to the tibio-peroneal trunk was performed using a reversed 12-cm-long saphenous vein graft retrieved from the right thigh. In the 3rd patient, the right popliteal vein was ligated, and a reversed 25-cm-long saphenous vein graft retrieved from the left thigh was used for a femoro-popliteal bypass. For the 3 patients, postoperative recovery was unremarkable. Pulses were present within 6-10 months of follow-up.

Whenever limb vascularity is compromised after an orthopaedic procedure, a high index of suspicion for an arterial injury should be exercised and prompt referral to the vascular service is mandatory. Repair of injured vessels with a saphenous vein graft provides excellent long-term results.