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Case Reports
. 2023 Dec;43(2):20-24.

Consideration for Limb Salvage in Place of Amputation in Complex Tibial Fracture With Neurovascular Injury: A Case Report

Deana M Mercer  1 , Hoang M Nguyen  1 , William Curtis  1 , John J Heifner  2 , David H Chafey  1
Affiliations
Case Reports

Consideration for Limb Salvage in Place of Amputation in Complex Tibial Fracture With Neurovascular Injury: A Case Report

Deana M Mercer et al. Iowa Orthop J. 2023 Dec.

Abstract

High-energy tibial fractures often present with associated soft tissue injuries, including neuro-vascular damage, complicating the treatment decision. A 33-year-old male presented with Gustilo Anderson type IIIA fracture of the left distal tibia and fibula with associated closed calcaneus fracture and tibial nerve transection. Amputation was discussed, but the decision was made for limb salvage with nerve allograft. The patient displayed satisfactory functional recovery at 29 months postoperatively without need for major revision, grafting, arthrodesis, or amputation. This case report provides an example of successful limb salvage utilizing tibial nerve allograft in a complex high-energy lower extremity injury. Level of Evidence: IV.

Keywords: limb salvage; lower extremity trauma; neurovascular injury; open tibial fracture; peripheral nerve allograft; tibial nerve injury.

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Conflict of interest statement

Disclosures: DM discloses speaker’s bureau with Skeletal Dynamics and Axogen, DC discloses education with Smith and Nephew. HN/ WC/JH have nothing to disclose.

Figures

Figure 1A-1E.
Figure 1A-1E.
Anteroposterior (A) and lateral (B) radiographs of left ankle and lateral radiograph of the foot (C) demonstrating comminuted intraarticular distal tibial, fibular, and calcaneal fractures. Intraoperative image of tibial nerve and posterior tibial artery transection (D) and tibial nerve allograft placement (E).
Figure 2A-2D.
Figure 2A-2D.
Anteroposterior (A) and lateral (B) radiographs at 4 years postoperatively demonstrating well healed fractures. Clinical image of patient demonstrating dorsiflexion (C) and ambulation (D).
See this image and copyright information in PMC

References

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