RESUMO
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.
RESUMO
INTRODUCTION AND IMPORTANCE: Osteochondroma, commonly known as exostosis, is a benign osteocartilaginous mass lesion frequently encountered in orthopaedic clinics. While its benign nature is of little concern, the impact on surrounding tissues can be significant, especially in the case of exostosis located in the distal tibia and fibula, which can damage the syndesmosis. CASE PRESENTATION: This report presents a rare case of exostosis of the talus that has progressed into the syndesmosis, causing distinct clinical and radiographic symptoms. The patient underwent excision of the lesion through the posterolateral ankle approach, and our main concern was about the approach to the syndesmosis. Ultimately, open reduction and screw fixation were performed for the patient. CLINICAL DISCUSSION: Exostosis in the talus area is generally uncommon in the literature review, and the presence of the lesion in the posteromedial surface area, as well as its entry and damage to the syndesmosis area, is even less common. Diagnosing the lesion through appropriate methods and a multidisciplinary team approach is crucial for correct diagnosis and treatment. Different approaches to managing syndesmosis have been reported, and suitable treatment for these cases is required. CONCLUSION: In conclusion, correct diagnosis and excision of the exostosis lesion are essential, but it is also necessary to appropriately identify and manage its adverse effects. The selection of an appropriate treatment strategy for managing these lesions is crucial.
