Delayed complete limb ischemia following a closed tibial shaft fracture.

We present a 19-year-old collegiate athlete who sustained a low-energy closed tibial shaft fracture. Following closed reduction, the dorsalis pedis and posterior tibial pulses were symmetric to the contralateral limb on physical examination. Angiography later confirmed triple vessel arterial disruption complicated by delayed ischemia requiring limb revascularization. Lower extremity triple vessel occlusion from a low-energy injury is rare, and delayed presentation requiring limb salvage is even more unusual. We review the literature, describe the diagnosis and treatment, and propose a strategy for post-fracture reduction management of vascular status.