Delayed Dorsalis Pedis Artery Pseudoaneurysm Following Open Reduction and Internal Fixation of a Lisfranc Injury: A Case Report

Vascular complications following operative fixation of Lisfranc injuries are rare and may present in a delayed manner. This report describes a case of a woman in her early 60s who sustained a Lisfranc fracture-dislocation following a fall from height and was treated with open reduction and internal fixation. Initial recovery was uncomplicated. The patient re-presented two months later with recurrent pulsatile bleeding from the dorsal midfoot wound and symptomatic anaemia. CT angiography revealed a 14 × 8 mm pseudoaneurysm arising from the dorsalis pedis artery adjacent to the fixation hardware. Diagnostic angiography confirmed thrombosis of the pseudoaneurysm with preserved distal arterial runoff. The patient was managed conservatively without surgical or endovascular intervention. This case highlights a clinically important but uncommon delayed vascular complication following Lisfranc fixation. It emphasises the role of early vascular imaging in patients presenting with delayed postoperative bleeding and demonstrates that conservative management may be appropriate in selected cases. Importantly, it underscores a decision-making paradigm in which intervention can be safely avoided when spontaneous thrombosis and adequate perfusion are present.