Case: A 17-year-old male patient presented with Salter-Harris type I hyperextension injury of left distal femur with delayed development of acute limb ischemia secondary to popliteal artery injury.
Conclusion: Popliteal artery injury associated with distal femoral physeal fracture may not be clinically obvious at the time of initial presentation. When initial pulse examination and segmental Doppler measurements are normal, it is important to perform serial examination by experienced examiners because arterial insufficiency may develop over the subsequent 48 hours. If unidentified, this can lead to significant disability and/or limb loss. This emphasizes the importance of serial monitoring along with judicious use of ankle brachial pressure index, pulse oximetry, and imaging.
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