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Traumatic Lower Extremity Arteriovenous Fistulae in Children
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Traumatic arteriovenous fistulae are rare injuries in the pediatric population. Most are caused by penetrating injuries or are post-surgical in nature. Fistulae resulting from non-penetrating injuries are often missed early in the course of physical examination. This occurs due to the absence of clinical signs of arterial or venous injury, despite the close proximity of the affected vessels to point of injury. Likewise, signs and symptoms of post-surgical vascular injury may be difficult to discern from normal postoperative discomfort. The astute clinician must be on alert for unusual presentations of vascular injury to intervene in an expeditious manner.
This article presents a series of vascular complications following either blunt injury or surgical management of the lower extremity in children who presented to our facility between November 2004 and December 2005.
Case Reports
Patient 1
An 11-year-old boy sustained closed fractures of his left distal tibia and fibula after jumping and subsequently falling 9 feet from the roof of his backyard shed. He was initially seen at a local emergency room where his fractures were splinted, and approximately 12 hours following the injury, he was transferred to our institution for further evaluation and management. Radiographs of the left leg revealed completely displaced oblique fractures of the distal third tibia and fibula.
Physical examination revealed palpable pulses in a tense, swollen left leg. Clinically the anterior and lateral compartments were the most taut, and warranted immediate fasciotomy. The patient was emergently taken to the operating room.
Intraoperative compartment pressures measured in the left leg were found to be elevated with an anterior compartment pressure of 40 mm Hg, lateral compartment pressure of 29 mm Hg, superficial posterior compartment pressure of 19 mm Hg, and deep posterior compartment pressure of 31 mm Hg.
The patient's blood pressure at presentation, consistent throughout his surgery...