# Pseudoaneurysm as an unusual complication in bone lengthening

## TL;DR

A rare case of a pseudoaneurysm in the anterior tibial artery is reported following a bone lengthening procedure in a diabetic patient.

## Contribution

This case highlights the late presentation of a pseudoaneurysm and the role of bony callus shape in its diagnosis.

## Key findings

- Pseudoaneurysm can occur as a late complication of tibial lengthening procedures.
- The shape of the bony callus can serve as a reliable indicator of pseudoaneurysm pathology.

## Abstract

One of the risks of distraction osteogenesis-based techniques is the development of vascular complications, such as pseudoaneurysms associated with the osteotomies performed or the fixation elements of the external fixator used in the procedure.

Pseudoaneurysm are formed when the tunica adventitia of the artery is injured, resulting in a gradual and persistent blood extravasation into the surrounding tissues that is encapsulated and connected to the arterial lumen.

This report describes a rare case of a late-presentation pseudoaneurysm in the anterior tibial artery resulting from a tibial lengthening procedure aimed at addressing a leg length discrepancy in a 57-year-old female with severe peripheral neuropathy resulting from long-standing poorly controlled diabetes mellitus. We describe the diagnostic process, the treatment options and confirm how the shape of the bony callus can be a reliable indicator of this pathology, as has already been described in the literature.