Amputation following internal fixation of an ankle fracture
A 39-year-old previously healthy woman sustained a dislocated trimalleolar ankle fracture as a result of a low-energy twisting injury. The fracture was reduced and stabilized at the emergency department. After reduction, the foot was vital and sensation and motor function were normal. Because of the tendency of the ankle joint to dislocate posteriorly, we decided to fix the posterior malleolar fracture with an anatomic locking plate through a posterolateral approach.

The surgery went according to plan and postoperative radiographs were considered acceptable (Figure 1). However, during the first postoperative day the patient developed severe pain in her foot that was unresponsive to pain medication. Sensation was impaired at the dorsal and plantar aspects of the foot. Active flexion of toes was intact, but passive extension of the foot caused pain at the level of the ankle. The foot was warm, but neither the dorsalis pedis artery nor the posterior tibial artery was palpable or could be detected with Doppler ultrasound.

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