External iliac artery entrapment associated with pelvic fracture. A case report

We report the case of a 64-year-old male cyclist who sustained a complex pelvic fracture after a fall. Initial imaging revealed an unusual finding: entrapment of the left external iliac artery within the pelvic fracture site, although distal perfusion remained intact. A multidisciplinary surgical approach was undertaken. The vascular team first freed the entrapped artery followed by stabilisation of the pelvic fracture using reconstruction plates by the orthopaedic team. Notably, no arterial injury was observed, though the vessel appeared tortuous and was at risk for compression or thrombosis. The patient's early postoperative course was uneventful, however at the one-year follow up radiographs show significant post-traumatic osteoarthritis and he has been advised to consider total hip arthroplasty. To our knowledge, this represents the first reported case of external iliac artery entrapment by a pelvic fracture. The case underscores the importance of early surgical exploration when arterial entrapment is suspected, even in the absence of bleeding or pulse deficit. Delay in intervention can result in thrombosis or ischemia. Clinicians should also be aware of underlying vascular anomalies, such as tortuous arteries, which may predispose patients to entrapment and complicate surgical management. • External iliac artery entrapment by a pelvic fracture is a rare but serious complication that may not present with distal vascular compromise. • Early CT imaging is crucial in complex pelvic fractures to identify vascular involvement, even in hemodynamically stable patients. • Multidisciplinary surgical planning involving vascular and orthopaedic teams is essential to safely manage arterial entrapment and prevent iatrogenic injury. • Anatomical variations such as a tortuous external iliac artery may increase the risk of entrapment. • Delayed recognition or non-intervention in arterial entrapment can result in thrombosis, limb ischemia, or complications from callus formation during fracture healing.