PMC7276617_01
Radiographs of the left lower leg at the time of the original injury.
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F1
He was found to have a left distal third oblique tibia fracture (Fig. 1) and was splinted in an outside emergency department that evening.
Radiographs of the left lower leg at the time of presentation to our institution.
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F2
Computed tomography images showing a channel along the lateral cortex of the distal tibia, suggestive of entrapment of the neurovascular bundle.
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F3
A CT scan was obtained for further evaluation and showed a tubular channel running through the lateral cortex of the distal third of the tibia, at the previous fracture site (Fig 3). The appearance was consistent with entrapment of the neurovascular bundle, warranting further imaging with an magnetic resonance imaging (MRI) (Fig. 3).
Magnetic resonance imaging showing the anterior tibial artery and deep peroneal nerve coursing through the distal tibia at the previous fracture site.
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F4
Intraoperative assessment showed the anterior tibial artery encased in cortical bone, at the fracture/nonunion site. There was no flow distally when the tourniquet was released. The peroneal nerve was found to be coursing freely and was not entrapped in bone.(Orientation: A and B are proximal; C and D are distal).
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F5
The anterior tibial artery was encased in bone, entering the tibial cortex approximately 9 cm above the tibiotalar joint and exiting approximately 4 cm above the tibiotalar joint (Fig. 5).
Radiographs at 4 weeks postoperatively.
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F6
Radiographs showed the cortical defect along the lateral distal tibia with signs of ongoing healing at the fracture site (Fig. 6).