Pathological Fracture of the Fibula Due to a Late Presenting Posterior Tibial Artery Pseudoaneurysm

Abstract

Accidental penetrating injury of the leg is common in the emergency room setting, and some patients have no bone injury on radiographs. We report a delayed sequel of vascular injury to the posterior tibial artery, following penetrating injury to the leg, which was later additionally complicated by pathological fracture of the proximal part of the fibula. Early diagnosis is important to provide timely treatment. The case of this patient illustrates that the delayed sequel of vascular injury may be confused clinically and on radiographs with a soft-tissue neoplasm. The patient was informed that data concerning the case would be submitted for publication, and he consented. A thirty-year-old man sustained a penetrating wound to the lateral aspect of the proximal part of the right leg fifteen months before presenting to our institution. After a radiograph showed normal findings, he was diagnosed as having a simple penetrating wound and was treated at a primary health center. He subsequently developed constant dull pain and mild swelling over the proximal part of the leg. The swelling and pain gradually increased. When the pain began to interfere with his daily activities, he presented to a private tertiary-care hospital. The radiographic provisional diagnosis was soft-tissue neoplasm. For further evaluation, fine-needle aspiration cytology, magnetic resonance imaging, and a radionucleotide scan were recommended. For economic reasons, he was unable to obtain these studies. He next presented to us with leg swelling and severe pain that interfered with his sleep and daily activities fifteen months after the injury. Clinical examination revealed a diffuse, tender 8 × 10-cm mass on the posterolateral aspect of the proximal part of the right leg. The overlying skin was warm and shiny. The mass was fixed with variable consistency from soft to firm. There was no palpable or …