Pseudoaneurysm of dorsalis pedis artery following lisfranc surgery: a rare complication

Aneurysm and pseudoaneurysm of the dorsalis pedis artery remains to be rare vascular entities with a reported incidence of 0.5% of peripheral arterial aneurysms. Only, few cases were reported. The formation of pseudoaneurysm is commonly associated with fracture, laceration wound or iatrogenic arterial injury. An arterial injury that coincides with pseudoaneurysm can initially be missed due to lack of clinical findings. Prompt recognition remains paramount to reduce morbidity and mortality. Here, we present a rare complication of a commonly performed orthopaedic procedure in a young male who presented with painful swelling over left foot after he was involved in an industrial injury. He presented again with a pulsating mass over his left foot after 2 months post fixation surgery of a Lisfranc injury. He was treated conservatively with compression bandage and able to regain to his normal activity after the treatment initiated

An unusual case of a true aneurysm of the dorsalis pedis artery in a young man — an eight years observation

We present a case of a 21-year-old man, physically active, a few months after a torsion injury of the left ankle periodically began to have persistent problems similar in nature to Raynaud’s phenomenon in the left foot, especially after exposure to cold and prolonged immobilization of the ankle, in ski shoes, for example. Initial Duplex Doppler ultrasonography revealed an abnormal lateral course of the distal segment of the left anterior tibial artery and the initial section of the dorsalis pedis artery and a small true aneurysm of the dorsalis pedis artery in the talus area. The changes were confirmed by a Computed Tomography Angiography test. At the same time, the immune and inflammatory origin of reported symptoms was excluded. After conservative treatment (rest, avoidance of cold temperatures, aspirin at a dose of 75 mg/day), relief of the symptoms was achieved during six-month medical supervision. During further observation, patient started again his physical activity (soccer, skiing). After 8 years of onset, he remains asymptomatic. He is observed as an out-patient

Pseudoaneurysm of the Anterior Tibial Artery following Tibio-Talar-Calcaneum Fusion with a Retrograde Nail: A Rare Case and Literature Review.

This study reports the case of an 87-year-old woman who presented with a nonresolving haematoma 13 weeks following tibiotalar arthrodesis surgery on her right ankle using a retrograde nail. This was revealed by angiography to be a pseudoaneurysm of the anterior tibial artery. The patient subsequently underwent endovascular stenting of the pseudoaneurysm and has had a successful recovery. This case highlights the need for awareness of both the normal arterial supply to the leg and ankle as well as the potential for anatomical variations. Arterial variation may be as high as 6.7% based on published findings from cadaveric studies. As pseudoaneurysm is a rare complication, a high index of suspicion is needed in order to avoid a missed or delayed diagnosis. We urge surgeons to keep in mind the potential for pseudoaneurysm when a patient presents with a nonresolving haematoma and arrange appropriate further investigations as needed

Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy : a fresh cadaveric study

Background: The deep plantar arch is formed by anastomosis of the lateral and deep plantar arteries. Osteotomy of the lesser metatarsals is often used to treat metatarsalgia and forefoot deformity. Although it is known that some blood vessels supplying the lesser metatarsals are prone to damage during osteotomy, there is little information on the distances between the deep plantar arch and the three lesser metatarsals. The aims of this study were to identify the distances between the deep plantar arch and the lesser metatarsals and to determine how osteotomy could damage the arch. Methods: Enhanced computed tomography scans of 20 fresh cadaveric feet (male, n = 10; female, n = 10; mean age 78.6 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery, and the distance from the deep plantar arch to each lesser metatarsal was measured on axial and sagittal images. Results: The shortest distances from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The shortest distances from the distal epiphysis to a line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal in the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the tarsometatarsal joint were 23.0, 21.0, and 18.6 mm. The deep plantar arch ran at the level of the middle third, within the proximal portion of this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) specimens, respectively, and at the level of the proximal third in 9/20 (45.0%), 13/20 (65.0%), and 11/16 (68.8%). Conclusions: Overpenetration into the medial and plantar aspect of the second metatarsal or the proximal and plantar aspect of the fourth metatarsal during shaft or proximal osteotomy could easily damage the deep plantar arch. Shaft or proximal osteotomy approximately 45–47 mm proximal to the distal epiphysis or 18–23 mm distal to the tarsometatarsal joint on the plantar aspect could interrupt blood flow in the deep plantar arch

Complications in ankle arthroscopy

PURPOSE: To determine the complication rate for ankle arthroscopy. METHODS: A review of a consecutive series of patients undergoing ankle arthroscopy in our hospital between 1987 and 2006 was undertaken. Anterior ankle arthroscopy was performed by means of a 2-portal dorsiflexion method with intermittent soft tissue distraction. Posterior ankle arthroscopy was performed by means of a two-portal hindfoot approach. Complications were registered in a prospective national registration system. Apart from this complication registry, patient records, outpatient charts and operative reports were reviewed. Patients with a complication were asked to visit our hospital for clinical examination and assessment of permanent damage and persisting complaints. RESULTS: An overall complication rate of 3.5 % in 1,305 procedures was found. Neurological complications (1.9 %) were related to portal placement. Age was a significant risk factor for the occurrence of complications. Most complications were transient and resolved within 6 months. Complications did not lead to functional limitations. Residual complaints did not influence daily activities. CONCLUSIONS: Our complication rate is less than half of what has been reported in literature (3.5 vs 10.3 %). The use of the dorsiflexion method for anterior ankle arthroscopy can prevent a significant number of complications. Posterior ankle arthroscopy by means of a two-portal hindfoot approach is a safe procedure with a complication rate that compares favourably to that of anterior ankle arthroscopy. LEVEL OF EVIDENCE: Retrospective prognostic study, Level II

Deep Peroneal Nerve: Orientation and Branching at the Ankle and Proximal Part of the Foot

Objective: This study investigated the frequency and types of 1) orientation of the deep peroneal nerve (DPN) and its branches relative to the dorsalis pedis artery (DPA) and the extensor hallucis longus tendon (EHLT) and 2) branching site and pattern of DPN at the distal area of leg and the proximal zone of the foot. Materials and Methods: One-hundred and sixty specimens from the lower extremities of 80 formalin-embalmed cadavers were investigated for anatomical position, orientation and the branching pattern of DPN by manual dissection, starting from the anterior side of lower extremity just proximal to ankle joint down to the area distal to inferior extensor retinaculum. Results: The most prevalent medial-to-lateral orientation of structures in the area anterior to ankle joints was the EHLT/DPA/DPN. Comparing DPA with the branching of DPN in the areas inside anterior tarsal tunnel (ATT) and distal to ATT, the most common type was an orientation of DPA that was lateral to both the DPN main trunk and its medial terminal branch. Regarding branching sites and patterns of DPN in the intermalleolar and ATT areas, nearly half of the studied specimens had DPN bifurcation at the intermalleolar level and more than half of the bifurcations were inside the ATT. Conclusion: This study establishes novel data regarding type variation and prevalence of DPN in areas of ankle and proximal part of foot in the Thai population which could be helpful in clinical practice

Delayed Acute Ischemia as a Consequence of Multi-Ligament Injury of the Left Knee Following a Motorcycle Accident

Motorcycle accidents can cause complex orthopedic and vascular injuries, posing diagnostic and treatment challenges. We present a case of a 34-year-old Albanian man with a multi-ligament knee injury and arterial thrombosis in his left leg following a motorcycle accident. The patient initially received conservative care but developed severe leg pain, coldness, and numbness, prompting urgent vascular imaging. Imaging confirmed popliteal artery thrombosis, necessitating surgical intervention. This case highlights the severe complications of motorcycle accidents, emphasizing the need for prompt vascular injury detection and a multidisciplinary approach in trauma management. Early recognition and timely intervention are crucial to prevent long-term morbidity and to optimize recovery. Further research is needed to improve diagnostic and treatment strategies for vascular complications in such injuries