Revascularization of a seven-week-old infant lower extremity: case report
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P A Clugston1, D J Courtemanche, I Lawson
1Section of Surgery, British Columbia Children's Hospital, Vancouver, Canada.
Insights
A seven-week-old infant experienced tibia and fibula fractures with vascular compromise. Successful revascularization using a vein graft led to a good functional outcome, highlighting the importance of timely intervention for pediatric limb injuries.
Area of Science:
- Pediatric Orthopedics
- Vascular Surgery
- Trauma Care
Background:
- Pediatric long bone fractures can lead to severe complications.
- Vascular disruption and compartment syndrome pose significant risks to limb viability in infants.
Observation:
- A seven-week-old infant presented with closed segmental tibia and fibula fractures.
- Clinical signs of vascular compromise (mottled, cool, pulseless extremity) were noted 4 hours post-injury.
- Radiographs confirmed displaced fractures; initial fasciotomies and intramedullary nailing did not restore vascularity.
Findings:
- Angiography revealed arterial inflow disruption distal to the tibial peroneal trunk.
- Urgent revascularization with a contralateral greater saphenous vein graft was successfully performed 22 hours post-injury.
- Despite transport delays and initial management challenges, the infant achieved a good-to-excellent functional outcome.
Implications:
- Early recognition and aggressive management of vascular injuries are critical in pediatric fractures.
- Vein grafting is a viable option for revascularization in complex pediatric limb trauma.
- Multidisciplinary care involving orthopedics and vascular surgery can improve outcomes in severe pediatric limb injuries.
Abstract:
A seven-week-old infant suffered a closed segmental fracture of the left tibia and fibula complicated by vascular disruption and a secondary compartment syndrome. Initial orthopedic assessment revealed a clinically mottled, cool, pulseless extremity 4 hr post-injury. Radiologic investigations showed multiple displaced fractures of both the tibia and fibula. The infant underwent four compartment fasciotomies and intramedullary nailing of the tibial fractures. The vascularity of the limb failed to improve significantly. Angiograms done 22 hr post-injury revealed disruption of arterial inflow just distal to the bifurcation of the tibial peroneal trunk and posterior tibial artery. Urgent revascularization utilizing a contralateral greater saphenous vein graft was undertaken with a successful outcome. Despite delay in transport from the community hospital and lack of definitive management of the vascular injury, the infant has had a good-to-excellent functional outcome.