Neurovascular Bundle Entrapment and Through Knee Amputation After Cerclage Cabling of Distal Femoral Peri-implant Fracture: A Case Report

• Published in: JBJS case connector Vol. 10; no. 1; p. e0194
• Main Authors: Panagopoulos, Andreas, Lachanas, Ioannis, Kouzelis, Antonis, Kokkalis, Zinon T, Tyllianakis, Minos
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Aged, 80 and over; Amputation, Surgical; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - surgery; Female; Femoral Artery - injuries; Femoral Fractures - surgery; Fracture Fixation, Internal - adverse effects; Humans; Internal Fixators - adverse effects; Periprosthetic Fractures - surgery; Postoperative Complications - etiology; Postoperative Complications - surgery; Vascular Surgical Procedures
• ISSN: 2160-3251
• DOI: 10.2106/JBJS.CC.19.00194

We report the case of an 82-year-old woman with diabetes, arteriosclerosis, chronic heart failure, and hypertension treated with an anatomical locking plate and multiple cables for a spiral-wedged periprosthetic fracture of the distal femur which was complicated by direct occlusion of the femoral artery and crush of the sciatic nerve, resulting in leg necrosis and, ultimately, through-knee disarticulation despite early recognition and arterial repair. Neurovascular injury is a potential complication of cerclage cables placement around the femoral shaft during complex fracture fixation. Devastating complications cannot always be corrected despite early vascular intervention.