𝗖𝗔𝗦𝗘 05
𝗟𝗶𝗺𝗯 𝗦𝗮𝗹𝘃𝗮𝗴𝗲 𝗔𝗳𝘁𝗲𝗿 𝗣𝗼𝗽𝗹𝗶𝘁𝗲𝗮𝗹 𝗔𝗿𝘁𝗲𝗿𝘆 𝗜𝗻𝗷𝘂𝗿𝘆 𝗔𝘀𝘀𝗼𝗰𝗶𝗮𝘁𝗲𝗱 𝘄𝗶𝘁𝗵 𝗮 𝗧𝗶𝗯𝗶𝗮𝗹 𝗣𝗹𝗮𝘁𝗲𝗮𝘂 𝗙𝗿𝗮𝗰𝘁𝘂𝗿𝗲
A 15-year-old boy was transferred from a regional hospital following a motorcycle-related road traffic accident.
Initial trauma assessment revealed a left tibial plateau fracture with no other significant injuries. Following exclusion of life-threatening conditions, attention was directed towards the injured limb.
Clinical examination demonstrated absent distal pulses in the affected leg, raising immediate concern for a vascular injury.
Given the combination of a high-energy knee injury and a pulseless limb, the patient was transferred directly to the operating theatre for limb salvage.
The orthopedic team first applied a spanning external fixator to stabilize the fracture and restore limb alignment.
Vascular exploration was then undertaken.
Operative findings revealed a significant injury to the distal popliteal artery (P3 segment) with segmental arterial loss.
The injured segment was unsuitable for primary repair.
Following proximal and distal vascular control, reconstruction was performed using a reversed great saphenous vein interposition graft harvested from the contralateral lower limb.
Following completion of the reconstruction, restoration of arterial flow was achieved with immediate return of satisfactory distal pulses and limb perfusion.
By the time revascularization was completed, the total ischemic time from injury to reperfusion exceeded six hours.
Given the prolonged ischemia and the high risk of reperfusion-related compartment syndrome, prophylactic fasciotomy was performed.
The fasciotomy was undertaken to protect muscle viability, prevent compartment syndrome, and maximize the chances of successful limb salvage.
The patient tolerated the procedure well and no immediate complications occurred.
Postoperatively, distal perfusion remained satisfactory with palpable distal pulses and a warm, well-perfused foot.
𝗞𝗲𝘆 𝗟𝗲𝗮𝗿𝗻𝗶𝗻𝗴 𝗣𝗼𝗶𝗻𝘁𝘀
A pulseless limb associated with a knee injury should be considered a vascular emergency.
Popliteal artery injuries remain among the most limb-threatening vascular injuries encountered in trauma surgery.
Early recognition and rapid transfer are critical to successful limb salvage.
Skeletal stabilization before definitive vascular reconstruction provides a stable framework for repair and protects the graft.
Autologous reversed great saphenous vein remains the conduit of choice for traumatic arterial reconstruction in young patients.
Ischemia time remains one of the strongest predictors of limb salvage.
Prophylactic fasciotomy should be strongly considered when reperfusion occurs after prolonged ischemia.
Successful management requires close collaboration between orthopedic, vascular, anesthesia, ICU, and nursing teams.
𝗞𝗘𝗬 𝗠𝗘𝗦𝗦𝗔𝗚𝗘
A knee fracture with absent distal pulses should always raise suspicion of a popliteal artery injury. Every hour of ischemia matters, and rapid recognition, stabilization, revascularization, and timely fasciotomy are often the difference between limb salvage and limb loss.
Patient details anonymized. Images shared for educational purposes with appropriate consent.
