Popliteal artery thrombosis resulting from a fracture of the proximal tibial epiphysis in a 12-year-old boy

Abstract

Proximal tibial epiphyseal fractures in children are very rare but the association to vascular complications in these types of injuries is notoriously known. However, the insidious presentation of popliteal vascular trauma especially in children can often be overlooked leading to limb-threatening ischemia. We describe a rare case of a 12-year-old boy, involved in a car accident, with popliteal artery thrombosis caused by intimal disruption, complicating a Shalter-Harris type I fracture of the proximal tibial epiphysis. Although capillary refill was less than 2sec in both feet, ipsilateral distal leg pulses were absent. The patient was treated with closed reduction and stabilization of the fracture. A reverse great saphenous vein graft was successfully used to replace the injured popliteal artery segment. In such injuries, a high index of suspicion for vascular trauma should be maintained even in a warm foot. Asymmetry of distal pulses necessitates further investigation of the arterial network. Prompt diagnosis and treatment of the fracture and vascular injury will allow limb salvage.