REVASCULARIZATION OF A 7-WEEK-OLD INFANT LOWER-EXTREMITY - CASE-REPORT

A seven-week-old infant suffered a closed segmental fracture of the le ft tibia and fibula complicated by vascular disruption and a secondary compartment syndrome. Initial orthopedic assessment revealed a clinic ally mottled, cool, pulseless extremity 4 hr post-injury. Radiologic i nvestigations showed multiple displaced fractures of both the tibia an d fibula. The infant underwent four compartment fasciotomies and intra medullary nailing of the tibial fractures. The vascularity of the limb failed to improve significantly Angiograms done 22 hr post-injury rev ealed disruption of arterial inflow just distal to the bifurcation of the tibial peroneal trunk and posterior tibial artery. Urgent revascul arization utilizing a contralateral greater saphenous vein graft was u ndertaken with a successful outcome. Despite delay in transport from t he community hospital and lack of definitive management of the vascula r injury, the infant has had a good-to-excellent functional outcome.