title: Aplastic Posterior Tibial Artery in the Presence of Trimalleolar Ankle Fracture Dislocation Resulting in Below-the-Knee Amputation.
abstract: We present an interesting, but unfortunate, case of an 86-year-old female who sustained a trimalleolar ankle fracture dislocation that resulted in below-the-knee amputation after open reduction and internal fixation of the fracture. To the best of our knowledge, this is the first case report describing popliteal variants that ultimately resulted in critical limb ischemia and below-the-knee amputation after foot and ankle trauma. The anatomic variation altered the expected outcome from a relatively straightforward surgical case. We introduce the previously described lower extremity Allen test and describe how it can be a useful adjunct in the initial physical examination of lower extremity trauma. The ability to identify abnormal distal perfusion to the foot could provide enough insight to warrant evaluating the patient with angiography or computed tomography angiography.
authors.affiliation: Resident, Division of Foot and Ankle Surgery, Swedish Medical Center, Seattle, WA.
authors.forename: Peter Andrew
authors.initials: PA
authors.lastname: Bellezza
authors.affiliation: Resident, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA.
authors.forename: Edward
authors.initials: E
authors.lastname: Elliott
authors.affiliation: Vascular Surgeon, Jefferson Surgical Clinic, Carilion Roanoke Memorial Hospital, Roanoke, VA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Conlee
authors.affiliation: Assistant Professor, Co-Section Chief, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA. Electronic address: jrclements@carilionclinic.org.
authors.forename: John Randolph
authors.initials: JR
authors.lastname: Clements
mesh_terms: D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D018810:Magnetic Resonance Angiography / Q000379:methods; D011150:Popliteal Artery / Q000002:abnormalities; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D035583:Rare Diseases; D013977:Tibia / Q000601:surgery; D016909:Tibial Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: below-the-knee amputation; critical limb ischemia; foot and ankle trauma; lower extremity Allen test; popliteal variants