Acute limb ischemia after posterior ankle dislocation with impingement and vasospasm of the anterior tibial artery: a case report and inpatient clinical algorithm

Introduction

Arterial vasospasms occurring from foot and ankle trauma, such as severe fracture dislocations, are under-reported throughout the foot and ankle literature. The tunica media of blood vessels is highly sensitive to external stimuli, such as trauma, compression, or traction, which can induce vasospasm.

Body

Here we describe a 25-year-old male who sustained a traumatic injury to the left ankle eliciting a posterior dislocation with associated fractures who subsequently had absent pedal pulses and unobtainable signal on a handheld doppler. CT-angiography revealed reduced vessel caliber along the course of the anterior tibial artery. Following bedside reduction and prior to scheduled surgical intervention, the patient spontaneously regained vascular flow to the lower extremity.

Conclusion

There are very limited reports of posterior ankle fracture dislocation creating an acute limb ischemia from vasospasms in the anterior tibial artery. This case report stands to portray the need for further reporting, follow up, and peri-operative management of patients with vascular compromise to the foot and ankle. A guideline was developed to assist clinicians in the inpatient setting with selecting appropriate imaging modalities to assess vascular status and identify potential compromise.