Abstract
IntroductionThe ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication.Case presentationWe report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.ConclusionWe recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.
Highlights
The ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall
We describe a case of external iliac artery thrombosis as a rare complication of the ilio-inguinal approach
Only one other case of ilio-inguinal-approach-associated arterial thrombosis not caused by vascular entrapment between the bone and the implant or in the fracture gap has been pub
Summary
In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography. The patient should be carefully monitored to detect any signs of iliofemoral arterial impairment. Palpable distal pulses should not, by themselves, be considered as evidence that all is well. Angiography or (when clinical signs are evident) surgical exploration should be considered. The risk of intimal tears or atherosclerotic plaque rupture as a result of tensile stresses occurring during the traumatic event, during preoperative traction, or during surgical manoeuvres, should not be underestimated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
