Torode & Zeig type IV fracture with a blunt injury of external iliac vessels with innovative arterial reconstruction by internal iliac translocation. A 12-year follow-up

Abstract

This report describes the case of a 4-years-old female, who was admitted due to motor vehicle accident, with pelvic Torode & Zeig type IV fracture, blunt trauma to the right external iliac artery and vein, and femoral nerve. Associated injuries included open fracture of the left femur, contaminated abdomen due to jejunal tear, and hemorrhagic shock. We performed Orthopedic Damage Control by fluid resuscitation, and ligation of the right iliac artery and vein. Orthopedic Damage Control was performed by external fixation of the pelvis, and titanium elastic nailing of the left femur. The patient was left without arterial blood supply to the right leg. We faced the dilemma of selecting the optimal method of arterial reconstruction, considering the pelvic contamination. PTFE graft was not considered due to caliber discrepancy of 6mm compared to 3mm of the child's external iliac artery, and a 30% probability of synthetic graft infection in a contaminated abdomen. To avoid the complications mentioned above, we used an autologous graft of the right internal iliac artery, which was translocated distally and anastomosed to the distal external iliac artery. A 12 years follow-up, with left femoral plating, hamstring to patellar transfer, and right talar arthrodesis was conducted. The artery grew with the patient with no need for replacement. Twelve years post-injury, the patient walks with circumduction of the right leg with left leg shortening treated with a lift heel of 4 cm. The patient has consented to this publication.

Keywords

• Pediatric pelvic blunt trauma
• Pediatric pelvic vascular injury
• Pediatric vascular reconstruction
• Pediatric torode & zeig type IV injury
• DCO (Damage control orthopedics)