Fracture of the Tibial Plateau with Lesions of the Poplite Artery and the Sciatic-Nerve External Poplite about a Case and Review of the Literature

Abstract

Introduction: Popliteal artery injuries are frequently encountered in case of fractures, dislocations or after penetrating trauma. Lower limb blunt traumas are associated to popliteal artery injuries in 28 to 46% of cases. Objective: Our objective was to report this particularity. Clinical examination: The evaluation of the tibial plateau fracture was performed with the Schatzker classification. The nervous injury was classified according to the Seddon classification. We did not find a classification for post-traumatic acute arterial injury. Results: There was a motor deficit of the common fibular nerve without sensitive deficit. The radiological examination showed a complex bicondylar fracture Schatzker 5. An open reduction and internal fixation with a buttress plate was planned and performed 4 days following the trauma. The postoperative follow-up was marked by the appearance of a distal necrosis of the 1st and 4th toes with coldness of the forefoot one week after the operation; the pedal and retro-tibial pulses were diminished. Doppler ultrasound and Angio-scan revealed a narrow stenosis of imprecise etiology due to artefacts related to the osteosynthesis material, however, there was a substitute blood network. The patient received curative-dose anticoagulants combined with Sintron and Aspegic. Discussion: Penetrating trauma is the main cause of vascular lesions in the extremities. They are followed by closed trauma including traffic accidents, falls and crushing. In addition, closed trauma can lead to slow progression of arterial insufficiency. Inadequate initial examination and delayed vascular repair lead to amputation in 60-80% of cases. It is therefore of paramount importance to evaluate the vascular state not only at the initial examination but above all repeatedly in the following hours and days. In our patient, edema was one of the factors which made difficult the proper monitoring of the distal pulse. Therefore, it seems appropriate to include in the monitoring of knee trauma, whether or not there is a fracture of the tibial plateau, more tests such as Doppler ultrasound, angiography, Angio-scan and MRI. Conclusion: The dogma which recommended the realization of MRI or even Angio-scan of the knee only after dislocations should be extended to the fractures of the tibial plateau especially in a context of high velocity and this at the beginning and at the end of the management.