External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report

We report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.The management of complex pelvic fractures is a major challenge in trauma surgery. In acetabular fractures, surgery via the ilio-inguinal approach is an established and routinely employed technique; alternative approaches are used less frequently. Recognized complications associated with the ilio-inguinal exposure are disruption of the retropubic anastomosis from the femoral to the obturator arterial systems, and damage to the lateral cutaneous nerve of the thigh; [1] major-vessel injuries are rare [2-6]. We describe a case of external iliac artery thrombosis as a rare complication of the ilio-inguinal approach. To our knowledge, this complication has been reported only once before in the current orthopaedic literature [1]. We wish to stress the need, in pelvic surgery, for preoperative circulation screening and close postoperative