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Vascular Injury During Lateral Close-Wedge Distal Femoral Osteotomy: A Case Report and Review of Surgical Principles Publisher



Firoozabadi MA1 ; Rezaee H2 ; Irani PT3 ; Ashkezari DD4 ; Mortazavi SMJ5
Authors
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Authors Affiliations
  1. 1. Associated Professor of Orthopedic Surgery, Knee Surgeon, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Orthopedic Resident, Department of Orthopedics, Imam Khomein Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Orthopedic Surgeon, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Orthopedic Surgeon, Fellowship of Knee Surgery, Orthopedics Departement, Imam Khomein Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran

Source: International Journal of Surgery Case Reports Published:2024


Abstract

Introduction: Knee malalignment can increase the risk of osteoarthritis. Osteotomies can correct limb deformities, but they come with the risk of complications such as cortical hinge fracture, hardware failure, pain syndrome, and infection. Vascular injury is rare, but it can lead to bleeding, limb ischemia, and swelling. If revascularization is delayed for over 12 h, it can result in poor outcomes. The work has been reported in line with the SCARE criteria. Case: A 41-year-old female underwent a lateral close-wedge distal femoral osteotomy. Postoperatively, no distal pulse was detected. An emergency vascular surgery consultation revealed popliteal vein penetration and popliteal artery thrombosis, probably during pin penetration. Revascularization was performed, and the patient was discharged without complications. At the three-year follow-up, the patient was in good health and without complications. Discussion: Knowledge of the femoral artery and vein's proximity to the apex of the wedge is crucial in lateral close wedge distal femoral osteotomy. Despite vascular injury with an oscillating saw, it can happen during guide pin insertion. Although Intraoperative massive bleeding can show vascular injury, lack of it was not a protective factor. Conclusion: During the process of pin insertion, it is important to ensure that the pin's orientation is directly lateral to the medial. This should be checked using the C-Arm by obtaining AP, Lat, and Oblique views. To check for intraoperative bleeding, the tourniquet should be deflated. Once the procedure is complete, it is important to check for any vascular injury by examining distal pulses and limb perfusion carefully, particularly in the recovery room. © 2024 The Author(s)