1168 Case Report: Lower Limb Trauma with Vascular and Orthopaedic Injury in a National Level Gymnast

Abstract

Abstract Traumatic injuries in high-functioning athletes can have devastating consequences and require cross-disciplinary management for both initial presentation and subsequent management. We would like to present the case of a 17-year-old female, national level gymnast who presented with a traumatic lower limb injury. During a run-up to a trampoline, her right knee gave way with immediate pain, deformity, and inability to weight-bear. At initial assessment she was noted to have a large joint effusion with inability to straight leg raise and Xray showed a tibial plateau avulsion fracture. Initially she was neuro-vascularly intact, however on splinting, posterior knee dislocation occurred with loss of foot pulses, sensation, and motor function of the lower leg. Computerised tomography angiogram showed an 8cm filling defect at the popliteal artery. A multidisciplinary approach between Vascular and Orthopaedics decided on initial surgical management with support from Paediatrics and Anaesthesia. The popliteal artery was approached posteriorly for long-term durability and function, despite the potential difficulty in exposure, with a medial approach bailout. Exposure of the popliteal artery revealed a section of torn intima with occlusion which was resected and replaced with a long saphenous vein interposition graft. Finally, four-quadrant fasciotomies and spanning external fixation of her knee was performed. Completion diagnostic angiogram confirmed graft patency and restored 2-vessel run off. The patient recovered from this limb-salvage procedure and although required several more orthopaedic procedures, she was eventually discharged mobilising with crutches. This case illustrates the importance of a multidisciplinary approach in managing complex trauma especially in high-performing individuals.