Late-onset pseudoaneurysms of lower limb arteries following late complications of orthopaedic constructs - Two cases and review of literature

INTRODUCTION & IMPORTANCE: Damage to the adventitial layer of an artery leads to pseudoaneurysm formation. Pseudoaneurysms caused by complications of orthopaedic constructs are rare. CASE PRESENTATION & CLINICAL DISCUSSION: Case report 01. A 27-year-old male presented with acute bleeding from an external fixator pin site. He had defaulted follow-up due to covid pandemic and presented with malunited distal tibia fracture and loosened Schanz pins. CT angiogram revealed a pseudoaneurysm of the peroneal artery over the loosened pin site. The patient underwent exploration and ligation of the peroneal artery. Case report 02. 86-year-old female presented with a gradually enlarging lump on her left anteromedial thigh for three months duration. She underwent open reduction and internal fixation of ipsilateral femur fracture 17 months back. She was found to have a pseudoaneurysm of the superficial femoral artery caused by exposed screws following bony erosion. Exploration and repair of “neck” the pseudoaneurysm was performed and the recovery was uneventful. CONCLUSION: Pseudoaneurysms are rare but carry devastating complications following various orthopaedic procedures. The common cause for the formation of pseudoaneurysms is trauma during surgery. But loosened Schanz screws and screws are also can be the cause. Early identification of a pseudoaneurysm and proper intervention will reduce morbidities.