External iliac artery thrombosis following open reduction of acetabular fracture by para-rectus approach: A case report

Background External iliac artery thrombosis is a rare vascular complication that can result in a series of serious adverse outcomes. Existing studies on external iliac artery thrombosis after open reduction of acetabular fracture have primarily focused on the classical ilioinguinal approach. However, despite the increasing use of the para-rectus approach for the management of complex acetabular fractures in recent years, no case of external iliac artery thrombosis following this approach have been reported. Case presentation: A 50-year-old female sustained a left acetabular both-column fracture following a 4-m fall. Initial management included symptomatic treatment and skeletal traction. On day 11, open reduction and internal fixation via the para-rectus approach were performed. Postoperatively, the patient exhibited left lower limb ischemia. Computed tomography angiography confirmed left external iliac artery occlusion. Emergency endovascular thrombectomy successfully retrieved a 10 cm thrombus, leading to resolution of symptoms and eventual discharge. Conclusion This case represents the first reported instance of external iliac artery thrombosis following acetabular fracture fixation via the para-rectus approach. It underscores that even minimally invasive approaches carry risks of vascular complications. Gentle intraoperative manipulation and meticulous vascular monitoring are essential to prevent such complications. Patient outcomes are closely associated with rapid identification of postoperative vascular abnormalities and timely interventional therapy.