Asymptomatic anterior neurovascular bundle entrapment in a high-energy pilon fracture: A case report

Abstract

Background: Neurovascular injury is a known complication of traumatic fractures. Neurovascular entrapment, however, occurs with less frequency and is more common in the upper extremity. The deep peroneal nerve and anterior tibial artery and vein lie directly on the distal anterior tibia and are at risk of entrapment in pilon fractures. The exact incidence of this finding less clear, but recognizing the possibility of entrapment, especially in a patient without symptoms, is important to avoid neurovascular damage. Case report: A 37-year-old man with no known past medical history presented with a pilon fracture after a 9-foot fall from a fence. The patient presented without motor or sensory deficits and had a palpable dorsalis pedis pulse. During the definitive surgery two weeks after the initial injury, there was an unexpected intraoperative finding of deep peroneal nerve as well as anterior tibial artery and vein entrapment within the fracture. Conclusion: Neurovascular entrapment should be recognized as a possible finding in pilon fractures, even in patients without neurovascular deficits. A high index of suspicion is warranted especially in the setting of high energy injuries. Recognizing and subsequently managing entrapment appropriately is critical to avoid iatrogenic neurovascular injury.

Keywords

• Pilon fracture
• Neurovascular entrapment
• Deep peroneal nerve
• Anterior tibial bundle
• Complications