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External iliac artery thrombosis following open reduction of acetabular fracture: a case report and literature review

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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Funding

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan

    Norio Yamamoto

  2. Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama City, 700-8558, Okayama, Japan

    Tomoyuki Noda

  3. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan

    Taichi Saito & Toshifumi Ozaki

  4. Department of Emergency Healthcare and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan

    Takenori Uehara

  5. Department of Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Yasunori Shimamura

Authors
  1. Norio Yamamoto
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  2. Tomoyuki Noda
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  3. Taichi Saito
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  4. Takenori Uehara
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  5. Yasunori Shimamura
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  6. Toshifumi Ozaki
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Corresponding author

Correspondence to Tomoyuki Noda.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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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 140, 481–485 (2020). https://doi.org/10.1007/s00402-019-03288-3

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  • DOI: https://doi.org/10.1007/s00402-019-03288-3

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