Abstract
Complications associated with secondary displacement and migration of the lesser trochanter fragment in trochanteric fractures are rare. The complaints expressed by the patient may be misunderstood and attributed to implant-associated or patient-specific problems likely to occur after surgery. This series illustrates potentially dangerous late complications caused by secondary migration of the lesser trochanter. It may help focus the surgeon's attention on possible functional impairment and severe late complications caused by displacement of the lesser trochanter in trochanteric fractures that require prompt intervention.
Similar content being viewed by others
References
Barquet A, Gelink A, Giannoudis PV. Proximal femoral fractures and vascular injuries in adults: incidence, aetiology and outcomes. Injury. 2015;46(12):2297–313. https://doi.org/10.1016/j.injury.2015.10.021.
Alwhouhayb M, Howard A. A false aneurysm mistaken for a DVT after hip surgery. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES. 2005;11(2):178–9.
Liu X, Liu Y, Pan S, Cao H, Yu D. Does integrity of the lesser trochanter influence the surgical outcome of intertrochanteric fracture in elderly patients? BMC Musculoskelet Disord. 2015;16:47. https://doi.org/10.1186/s12891-015-0492-7.
Sun Q, Ge W, Hu H, et al. The influence of position of the displaced lesser trochanter on clinical outcome of unstable trochanteric femur fractures in the elderly. BioMed Res Int. 2018;2018:1–6. https://doi.org/10.1155/2018/5013646.
Schenkel M, Kaniewska M, Bühler T, Anderson S, Eid K. No difference in flexion power despite iliopsoas fatty degeneration in healed hip fractures with large lesser trochanter displacement. Eur J Orthop Surg Traumatol. 2018;28(7):1313–9. https://doi.org/10.1007/s00590-018-2200-4.
Lewin JR. The arteriographic diagnosis of a pseudoaneurysm of the femoral artery resulting from an orthopedic device. Vasc Dis. 1966;3(5):332–4.
Horton RE. Arterial injuries complicating orthopaedic surgery. J Bone Jt Surg Br. 1972;54(2):323–7.
Dameron TB. False aneurysm of femoral profundus artery resulting from internal-fixation device (screw). J Bone Jt Surg Am J Bone Jt Surg Am. 1964;46:577–80.
Rana N, Dhaked G, Sharma S, Tripathi S. Unusual presentation of pseudoaneurysm with trochanteric fracture femur with associated long-term antiepileptic therapy. Case Rep Orthop. 2014;2014:1–4. https://doi.org/10.1155/2014/896968.
Medlock G, McCullough L, Barker S. Femoral vein injury from a trochanteric hip fracture. Injury. 2015;46(6):1171–3. https://doi.org/10.1016/j.injury.2015.03.004.
Choa RM, Shanmugam S, Molloy A, Narayan B. Femoral vein injury in an intertrochanteric fracture: a case report. Inj Extra. 2009;40(8):155–7. https://doi.org/10.1016/j.injury.2009.04.007.
Piolanti N, Giuntoli M, Nucci AM, Battistini P, Lisanti M, Andreani L. Profunda femoris artery pseudoaneurysm after intramedullary fixation for a pertrochanteric hip fracture. J Orthop Case Rep. 2017;7(2):4.
Labronici PJ, Santos Filho FCD, Diamantino YLO, Loureiro E, Ezequiel MCDG, Alves SD. Proximal femur fracture and vascular injury in adults-case report. Rev Bras Ortop. 2019;54(3):343–6. https://doi.org/10.1016/j.rbo.2017.09.003.
Abraham E, Pankovich AM, Jansey F. False aneurysm of the profunda femoris artery resulting from intertrochanteric fracture. A case report. J Bone Jt Surg Am. 1975;57(6):871.
Whitehill R, Wang GJ, Edwards JR, Stamp WG. Late injuries to femoral vessels after fracture of the hip. Case report. J Bone Jt Surg Am. 1978;60(4):541–2.
Søballe K, Christensen F. Laceration of the superficial femoral artery by an intertrochanteric fracture fragment. A case report. J Bone Jt Surg Am. 1987;69(5):781–3.
Keel JD, Eyres KS. Vascular injury by an intertrochanteric fracture fragment. Injury. 1993;24(5):350–2. https://doi.org/10.1016/0020-1383(93)90065-e.
Murphy PG, Geoghegan JG, Austin O, More-O’Ferrall R, Quinlan WR, Keaveny TV. Pseudoaneurysm of the profunda femoris artery due to intertrochanteric fracture of the hip. Arch Orthop Trauma Surg. 1999;119(1–2):117–8. https://doi.org/10.1007/s004020050372.
Nielsen KD, Dammen I. Late symptoms after hip fracture with displacement of the lesser trochanter—a case report. Acta Orthop Scand. 2003;74(4):500–1. https://doi.org/10.1080/00016470310017866.
Bernstein I, Geks J, Walthers EM, Schnabel M. False aneurysm and bleeding caused by a secondary dislocated lesser trochanter fragment. Unfallchirurg. 2004;107(12):1192–5. https://doi.org/10.1007/s00113-004-0791-1.
Rommelmann P. Compression of the femoral nerve by a secondarily dislocated fragment of the lesser trochanter following pertrochanteric fracture of the femur. Unfallchirurg. 2007;110(7):645–7. https://doi.org/10.1007/s00113-007-1290-y.
Ritchie ED, Haverkamp D. False aneurysm of the profunda femoris artery, a rare complication of a proximal femoral fracture. Acta Orthop Belg. 2007;73(4):530–2.
Popovic D, Stankovic S. Deep femoral artery injury caused by non-fixed lesser trochanter 1 month after osteosynthesis. Injury Extra. 2008;39(10):337–40. https://doi.org/10.1016/j.injury.2008.06.011.
Lohmann H, Esenwein S, Geier B, Vogel T, Kleinert H. False aneurysm of the deep femoral artery due to pertrochanteric fracture of the hip with displaced fragment of the lesser trochanter. Z Orthopadie Unfallchirurgie. 2009;147(1):23–5. https://doi.org/10.1055/s-2008-1039115.
Tomčovčík L, Kováč P, Daňo J, Čuha R. Late laceration of the superficial femoral artery by an intertrochanteric fracture fragment. Hip Int J Clin Exp Res Hip Pathol Ther. 2011;21(2):273–5. https://doi.org/10.5301/HIP.2011.6512.
Jack N. Helleman, Vos DI, van der Laan L. Pseudoaneurysm of the deep femoral artery after pertrochanteric hip fracture: a case report. Vasc Dis Manag. 2011;8:E119–E120. https://www.hmpgloballearningnetwork.com/site/vdm/content/pseudoaneurysm-deep-femoral-artery-after-pertrochanteric-hip-fracture-case-report.
Osagie L, Gallivan S, Pearse Y. Profunda femoris injury following lesser trochanter displacement: complications following intramedullary femoral nailing. Injury. 2015;46(2):411–3. https://doi.org/10.1016/j.injury.2014.09.021.
Regus S, Lang W. Arterial injury and pseudoaneurysm formation after lesser trochanter fracture. Int J Surg Case Rep. 2015;14:4–6. https://doi.org/10.1016/j.ijscr.2015.06.033.
Neubauer Th, Grechenig St, Leitner L, Auffarth A, Plecko M. Vascular complications in plating of the proximal femur: review. Arch Orthop Trauma Surg. 2016;136(4):539–51. https://doi.org/10.1007/s00402-015-2406-4.
Lee PYF, Rao PVR, Golding DM, Brock J. Delayed profunda femoris artery bleeding after intramedullary nailing of an unstable intertrochanteric fracture: a case report. JBJS Case Connect. 2017;7(3): e60. https://doi.org/10.2106/JBJS.CC.16.00217.
Kanovsky A, Mueller EJ, Miller E. Secondary profunda femoris artery injury after intramedullary femoral nailing in a geriatric pertrochanteric femur fracture: case report. Eur J Orthop Surg Traumatol. 2019;29(8):1811–4. https://doi.org/10.1007/s00590-019-02500-9.
de Raaff CA, van Nieuwenhuizen RC, van Dorp TA. Pseudoaneurysm after pertrochanteric femur fracture: a case report. Skeletal Radiol. 2016;45(4):575–8. https://doi.org/10.1007/s00256-015-2315-1.
Funding
The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Contributions
AH had the idea for the article; DA, RM, and MD performed data collection and analysis; DA, TR, and KS performed literature search and analysis; DA, KS, and AH wrote the original draft; TR, KS, RM, and MD performed review and editing; AH supervised the work. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
AH has received consultant honoraria from Marquardt GmbH and Osartis GmbH, Germany. AH is an unpaid member of the AOTrauma Germany advisory board. All other authors have no relevant financial or non-financial interests to disclose. Authors are required to disclose financial or non-financial interests that are directly or indirectly related to the work submitted for publication.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Altherr, D., Ruffing, T., Schmitz, K. et al. Trochanter migrans: late complications due to displacement of the lesser trochanter in trochanteric fractures. Eur J Trauma Emerg Surg 49, 885–891 (2023). https://doi.org/10.1007/s00068-022-02143-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-022-02143-2