We report the case of an 80-year-old female with anterior tibial artery injury during open reduction and internal fixation (ORIF) of the tibia. She sustained bilateral lower limb degloving injuries and an open right tibial fracture in a traffic accident. CT angiography demonstrated occlusion of the posterior tibial and peroneal arteries, and right anterior tibial artery displacement. She underwent external fixation of the right tibia at the time of injury. ORIF of the right tibia was performed once the degloving injury healed. Postoperatively, her right foot felt cold with an absent dorsal artery pulse on Doppler auscultation. The posterior tibial artery pulse was present and her toe bled on needle puncture. CT angiography revealed occlusion of the anterior tibial artery at the fracture site with bypass from the posterior tibial and peroneal arteries to the posterior tibial artery. She underwent re-operation for revascularization using the saphenous vein. Postoperatively, the dorsal artery pulse became palpable and foot circulation improved. Arterial injuries in the lower leg do not always exhibit typical symptoms. In the case of poor foot circulation, arterial injury should be considered.
