Pseudoaneurysm of the popliteal artery in a child: an unusual complication of reconstruction of traumatic tibial fracture using Kirschner wire

Çocuk hastada popliteal arterde yalancı anevrizma: Travmatik tibial kırık rekonstrüksiyonunda kullanılan Kirshner çivisinin alışılmadık bir komplikasyonu

Abstract

s of the lower extremity due to falling, including left tibial fractures that required a Kirschner wire (KW) insertion. The device had been inserted around the left knee for the treatment of tibial fracture (Fig. 1). He had experienced sharp pains in his leg and demanded that the KW be removed. The pain did not subside after this treatment, and his family did notice the pulsatile mass in his left leg at that time. Four months before presentation to our institution, the patient had felt a sudden pain and experienced swelling in his left leg. On physical examination, the patient was afebrile and hemodynamically stable. Locally, a 5x7 cm nontender pulsatile mass was recorded in the medial aspect of the lower left popliteal area. The distal pulses were patent. Magnetic resonance imaging revealed a 5x6x8 cm heterogeneous mass along the left popliteal artery (Fig. 2). Because the artery fed distal runoff vessels, computed tomography angiography was also performed, and a localized pseudoaneurysm was found, with medial displacement of the left popliteal artery and adequate distal runoff (Fig. 3). Open surgery using a medial approach to the popliteal artery aneurysm was done. The distal popliteal artery was clearly exposed. After systemic heparinization, the proximal and distal popliteal artery was clamped and the aneurysm sac was opened longitudinally. A large volume of hematoma was evacuated. End-to-end popliteal artery anastomosis using a 7/0 polypropylene suture was performed. The patient’s postoperative course was uneventful, and he was discharged home on the 5th postoperative day. Upon discharge, the patient had palpable equal distal runoff in lower extremities. DISCUSSION Pediatric vascular trauma is a severe clinical condition, accounting for about 1% of pediatric trauma admissions in one multicenter experience.[1] The upper Pseudoaneurysm of the popliteal artery in a child: an unusual complication of reconstruction of traumatic tibial fracture using Kirschner wire Çocuk hastada popliteal arterde yalancı anevrizma: Travmatik tibial kırık rekonstrüksiyonunda kullanılan Kirshner çivisinin alışılmadık bir komplikasyonu Mustafa YILMAZ, Ömer Faruk DOĞAN, Murat GÜVENER, Tanzer SERTER Ciddi vücut travmalarından sonra gelişen iskelet kırıklarının tedavilerinde genel olarak Kirschner çivileri ortopedik cerrahlar tarafından giderek artan biçimde kullanılmaktadır. Kirschner (K) çivisine bağlı olarak yara yerinde hematom veya dokularda yırtık gibi değişik komplikasyonlar literatürde bildirilmiştir. Ancak, bildiğimiz kadarıyla K-çivisine bağlı olarak popliteal arterde yalancı anevrizma gelişimi İngilizce literatürde daha önce bildirilmemiştir. Bu yazıda, K-çivisi yerleştirildikten sonraki geç dönemde popliteal arterde yalancı anevrizma gelişen bir çocuk hasta sunuldu.

Özet

Kirschner pins are being increasingly used by orthopedic surgeons in the treatment of skeletal fractures after severe bodily injuries. As a result, there have been reports in the literature about the various complications caused by the Kirschner pin, such as wound laceration or hematoma. However, to our knowledge, pseudoaneurysm of the popliteal artery due to Kirschner pin in the late postoperative period has not been reported previously in the English literature. Herein, we present a child with pseudoaneurysm of the popliteal artery after reconstruction of a tibia fracture using Kirschner pin insertion.