Skip to main content

Advertisement

Log in

Secondary profunda femoris artery injury after intramedullary femoral nailing in a geriatric pertrochanteric femur fracture: case report

  • Up-to date Review and Case Report • HIP - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

We present a case of a secondary injury to the femoral artery in a geriatric male patient who sustained a pertrochanteric femoral fracture. Six days after closed fracture reduction and intramedullary femoral nailing, the patient presented with persistent hematocrit level drops, femoral swelling and pain. A computed tomography angiography of the femur revealed a perforation of the profunda femoris artery through the dislocated lesser trochanter fragment, and immediate surgical revision was induced. The patient returned to his pre-injury mobilization level without any peripheral vascular or neurological deficiencies. A literature review suggests that the occurrence of vascular damage in proximal femoral fractures is rare but mainly presents in geriatric patients due to atherosclerosis and brittle bone mass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lazarides MK, Arvanitis DP, Dayantas JN (1991) Iatrogenic arterial trauma associated with hip surgery: an overview. Eur J Vasc Surg 5:549–556

    Article  CAS  Google Scholar 

  2. Ryzewicz M, Robinson M, McConnell J, Lindeque B (2006) Vascular injury during fixation of an intertrochanteric hip fracture in a patient with severe atherosclerosis. JBJS 88:2483–2486

    Article  Google Scholar 

  3. Osagie L, Gallivan S, Pearse Y (2015) Profunda femoris injury following lesser trochanter displacement: complications following intramedullary femoral nailing. Injury 46:411–413

    Article  Google Scholar 

  4. Hyde Z, Mylankal KJ, Hankez GJ et al (2013) Peripheral arterial disease increases the risk of subsequent hip fracture in older men: the health in men study. Osteoporos Int 24(5):1683–1688

    Article  CAS  Google Scholar 

  5. Lim SJ, Yeo I, Yoon PW et al (2018) Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int 29(11):2427–2435

    Article  CAS  Google Scholar 

  6. Karanikas I, Lazarides M, Arvanitis D et al (1993) Iatrogenic arterial trauma associated with hip fracture surgery. Acta Chir Belg 93:284–286

    CAS  PubMed  Google Scholar 

  7. Nasr AY, Badawoud MH, Al-Hayani AA et al (2014) Origin of profunda femoris artery and its circumflex femoral branches: anatomical variations and clinical significance. Folia Morphol 73(1):58–67

    Article  Google Scholar 

  8. Patelis N, Koutsoumpelis A, Papoutsis K, et al (2014) Iatrogenic injury of profunda femoris artery branches after intertrochanteric hip screw fixation for intertrochanteric femoral fracture: a case report and literature review. Case reports in vascular medicine

  9. Laohapoonrungsee A, Sirirungruangsarn Y, Arpornchayanon O (2005) Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report. J Med Assoc Thail 88(11):1703–1706

    Google Scholar 

  10. Barquet A, Gelink An Giannoudis PV (2015) Proximal femoral fractures and vascular injuries in adults: incidence, aetiology and outcomes. Injury 46:2297–2313

    Article  Google Scholar 

  11. Whitehell R, Wang GJ, Edwards JR et al (1978) Late injuries to the femoral vessels after fracture of the hip. Case report. JBJS Am 60(4):541–542

    Article  Google Scholar 

  12. Keel JD, Eyres KS (1993) Vascular injury by an intertrochanteric fracture fragment. Injury 24(5):350–352

    Article  CAS  Google Scholar 

  13. Klanke J, Stepanek E, Wetermann K (2002) Injury of a branch of the arteria profunda femoris after a pertrochanteric femur fracture. Osteosynth Trauma Care 10(2):76–80

    Article  Google Scholar 

  14. Moreyra CE, Lavernia CJ, Cooke CC (2004) Late vascular injury following intertrochanteric fracture reduction with sliding hip screw. J Surg Orthop Adv 13(3):170–173

    PubMed  Google Scholar 

  15. McQueen MM, Gaston P, Court-Brown C (2000) Acute compartment syndrome. Who is at risk? JBJS 82(2):200–203

    Article  CAS  Google Scholar 

  16. Brunner A, Joeckel JA, Babst R (2008) The PFNA proximal femur nail in treatment of unstable proximal femur fractures: 3cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma 22(10):731–736

    Article  Google Scholar 

  17. Bonnaire F, Weber A, Boesl O et al (2007) ‘Cutting out’ bei pertrochantaeren frakturen-ein problem der osteoporose? Unfallchirurg 110(5):425–432

    Article  CAS  Google Scholar 

  18. Lucke M, Burghardt RD, Siebenlist S et al (2010) Medial migration of lag screw with intrapelvic dislocation in gamma nailing-a unique problem? A report of 2 cases. J Orthop Trauma 24:e6–11

    Article  Google Scholar 

  19. Weil YA, Gardner MJ, Mikhail G et al (2008) Medial migration of intramedullary hip fixation devises: a biomechanical analysis. Arch Orthop Trauma Surg 128(2):227–234

    Article  Google Scholar 

  20. Flint JH, Sanchez-Navarro CF, Buckwalter JA et al (2010) Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms. Orthopedics. https://doi.org/10.3928/01477447-20100225-19

    Article  PubMed  Google Scholar 

  21. Brodell JD, Leve AR (1983) Disengagement and intrapelvic protrusion of the screw from a sliding screw-plate device. JBJS Am 65(5):697–701

    Article  CAS  Google Scholar 

  22. Lee JM, Cho Y, Kim J et al (2017) Wiring techniques for the fixation of trochanteric fragments during bipolar hemiarthroplasty for femoral intertrochanteric fracture: clinical study and technical note. Hip Pelvis 29(1):44–53

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amelie Kanovsky.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kanovsky, A., Mueller, E.J. & Miller, E. Secondary profunda femoris artery injury after intramedullary femoral nailing in a geriatric pertrochanteric femur fracture: case report. Eur J Orthop Surg Traumatol 29, 1811–1814 (2019). https://doi.org/10.1007/s00590-019-02500-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02500-9

Keywords

Navigation