Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.

Posttraumatic pseudoaneurysm of medial plantar artery in a child: treatment with percutaneous thrombin injection / Pseudoaneurisma pós-traumático de artéria plantar medial em criança: tratamento percutâneo com injeção de trombina

Pseudoaneurysms of the medial plantar artery are rare. The authors describe a case of a pseudoaneurysm of the medial plantar artery of a child who had suffered a penetrating laceration injury. Diagnosis can be confirmed using Doppler ultrasound and magnetic resonance angiography. As an alternative to the conventional surgery technique, percutaneous Doppler ultrasound-guided thrombin injection is a safe and effective treatment.

O pseudoaneurisma da artéria plantar medial é raro. Os autores relatam um caso de pseudoaneurisma da artéria plantar medial após lesão perfurocortante em criança. O diagnóstico pode ser confirmado por ultrassom com Doppler e angiorressonância magnética. Em contraponto à técnica cirúrgica convencional, o tratamento pode ser feito de maneira efetiva e segura com a injeção percutânea de trombina assistida pelo ultrassom com Doppler.

Tratamiento de las úlceras venosas de los miembros inferiores por la vía intradérmica / Intradermic treatment of lower extremities chronic venous ulcers

Evaluar la eficacia del tratamiento de las úlceras venosas de los miembros inferiores por vía intradérmica. Estudio realizado en la Clínica Santa Sofía, Caracas. Se trata de un estudio prospectivo en 19 pacientes, 10 del sexo femenino y 9 del sexo masculino, los cuales presentaron úlceras en miembros inferiores de etiología vascular, con un promedio de edad de 60 años. Se trataron por vía intradérmica con sustancias que estimulan elementos importantes del tejido conectivo. El proceso de cicatrización de la úlcera se hizo progresivo a partir de la cuarta semana de tratamiento, con un cierre total de la úlcera a las 12 semanas. La intradermoterapia puede ser una alternativa en el tratamiento de las úlceras venosas de los miembros inferiores cuando no respondan a otras terapias aplicadas.

[Angiographic findings of arterial injuries in extremity trauma]

Nowadays traumatic injuries are the third cause of mortality in human societies and vascular injury as a main part of them are one of the main problems in medicine. Tissue ischemia resulted from vascular injuries is an emergency and if it continues irreversible ischemia and damage will result after 6 hours. In vascular injuries, early diagnosis and treatment is very important. Since the causes, types and resulting damages are different in our country from developed countries, we designed this study to compare these factors based on angiography which is the method of choice in vascular injuries. In this descriptive - analytical study, 75 patients with vascular injuries were studied by angiography in Imam Khomeini Hospital of Tabriz during 12 months. 94.7% of our patients were male and remaining 5.3% were female. The most common cause of trauma in this study was traffic accidents [93.3%] and the most common site of trauma was leg [62.2%] and associated fracture was detected in 86.75% of cases. The most common fracture was double fracture of leg [55.4%]. The most common injured artery was anterior tibial artery [36%] and the most common type of vascular injuries was complete arterial occlusion [62.7%]. Vascular injuries were more common in young males than the other groups and the most common cause was blunt trauma specially motorcycle accidents

Tratamiento de las fracturas cerradas de meseta tibial con tutor híbrido tipo llizarov en el Hospital Central de Maracay: enero-noviembre de 2003 / Treatment of closed fractures of the tibial plateau with hybrid type llizarov tutor at the Hospital Central de Maracay: january-november 2003

Se realizó un estudio prospectivo, exploratorio, longtudinal y de campo del tratamiento de seis pacientes con tutor externo híbrido tipo llizarov, en fracturas de meseta tibial en el Hospital Central de Maracay, de enero a noviembre de 2003. Se evaluaron según los criterios clínicos de Rasmussen y desde el punto de vista radiológico adaptaron de los criterios de Rasmussen para realizar dicha evaluación. Se incluyeron los pacientes que presentaban fracturas cerradas de meseta tibial tipos IV, V y VI según Schatzker, sin hundimientos de los platillos, que presentaron cierre del núcleo de crecimiento epifisario, fracturas no consolidadas y a los pacientes que adquirieron material de síntesis. Se realizó un seguimiento clínico radiológico hasta la 4ª semana posterior al retiro del tutor. Se trató al 40 por ciento de los pacientes que consultaron, el grupo etario más afectado fue entre 45 y 54 años con un 33,3 por ciento, el sexo masculino predominó con un 67 por ciento, según los criterios de Rasmussen se obtuvo un 67 por ciento de exelentes resultados y un 33 por ciento de buenos resultados. Radiológicamente se obtuvo un 50 por ciento de buenos resultados y 50 por ciento entre regulares y malos. Los resultados clínicos y radiológicos globales sugieren que el método promete ser una buena alternativa en el tratamiento de las fracturas de meseta tibial, por lo que es recomendable continuar su estudio.

Distribuicao anatomica e significancia funcional do trato iliotibial / Anatomic distribution and functional significance of the iliotibial tract

O trato ílio-tibial é um componente do sistema fascial dos menbros inferiores localizado na face lateral da coxa. Sua localizaçao e constituiçao o tornam bastante suscetivel a alteraçoes de tensao.Este trabalho consiste numa revisao da literatura, que tem por objetivo estabelecer comparaçoes entre os relatos de cada autor consultado, a fim de se obter esclarecimentos quanto a anatomia e funçao do trato ílio-tibial e quais sai as estruturas relacionadas a ele. Conclui-se que uma visao complet do trato ilio-tibial pode ser essencial para uma avaliaço fisioterapeutica, visto que ele envia fibras para outras estruturas e, cosequentemente, sofre alteraçoes de tensao em diversas condiçoes de anormalidade do sistema musculo-esqueletico.

Arterial injuries of the lower extremity from blunt trauma.

Thirty patients with 33 arterial injuries from blunt trauma of the lower extremity at Chulalongkorn Hospital, Bangkok, Thailand from January 1989 to December 1995 were reviewed. Eight patients (26.6%) were in shock on arrival. Twenty four (80%) presented with signs of ischemia. Twenty six (86.7%) had associated fractures and/or dislocations, 14 of them were compound fractures. Nine (30%) had associated injuries at other parts of the body. Ten (33.3%) underwent preoperative angiography. The preoperative time ranged from 1 to 72 hours, median 4 hours. One patient who had intimal tear of the popliteal artery and was successfully treated conservatively. Popliteal artery was the most common injured artery; followed by common femoral, superficial femoral, and anterior tibial artery. Most arterial injuries were repaired by using reversed saphenous vein grafts. Associated venous injuries were repaired in 5 patients. Fracture fixation was performed in 18 patients; 8 of them were performed before arterial repair and 10 were performed after arterial repair. No intravascular shunt was inserted in this study. Fasciotomy was performed in 15 patients. Five patients had limb amputation (16.7%). Univariate analysis by Chi Square test revealed that associated venous injuries, severe soft tissue injuries, and fasciotomy were statistically significant factors associated with amputation. One patient who had external iliac artery injury died from severe head injury in spite of a successful arterial repair (mortality rate 3.3%).