Arterial Injury to the Profunda Femoris Artery following Internal Fixation of a Neck of Femur Fracture with a Compression Hip Screw

Abstract

We report the case of an 82-year-old woman who developed extensive proximal thigh swelling and persistent anaemia following internal fixation of an extracapsular neck of femur fracture with a dynamic hip screw (DHS). This was revealed to be a pseudoaneurysm of a branch of profunda femoris artery on angiography. Her case was further complicated by a concurrent pulmonary embolism (PE). She underwent endovascular coil embolisation of the pseudoaneurysm. An IVC filter was inserted and the patient was fully anticoagulated once it had been ensured that there was no active bleeding. In this case, we review the potential for anatomical variations in the blood supply to this region and discuss treatment options for a complicated patient. We recommend that a pseudoaneurysm should be part of a differential diagnosis for postoperative patients with anaemia refractory to blood transfusion so as not to miss this rare but potentially serious complication.

The origin of the medial circumflex femoral artery: a meta-analysis and proposal of a new classification system

“…Physicians must be aware of an MCFA originating from the CFA, as this high origin of the artery has been associated with increased risk of MCFA puncture during cardiac interventional procedures and with iatrogenic injuries during femoral vein phlebotomy in infants (Shiny Vinila et al, 2013). Furthermore, a high originating MCFA may alter a surgeon’s perception of their location with respect to the major vasculature, leading them to believe they are farther away from important vessels than they actually are Craxford, Gale & Lammin, (2013).…”

Profunda Femoris Pseudoaneurysm and Fatal Hemorrhage 2 Weeks After Modified Girdlestone Resection Arthroplasty

“…In most cases, the injury results in a pseudoaneurysm, where extravasated blood is contained by a hematoma, leading to turbulent blood flow and a high risk of further bleeding 7 . Most reported cases of profunda femoris injury and resultant pseudoaneurysm after orthopaedic surgery occurred after internal fixation of PFFs [1][2][3][4][8][9][10][11][12][13][14][15][16][17][18][19][20] . However, there have been rare reports of profunda femoris artery injury from other orthopaedic procedures, such as total hip arthroplasty [21][22][23][24][25][26] and anterior cruciate ligament reconstruction 27 .…”

Lateral circumflex femoral artery false aneurysm as a complication of intertrochanteric hip fracture with displaced lesser trochanter

“…Cases have been described to be diagnosed from the third post-operative day to 14 years after the fracture [6], although the diagnosis at the moment of lesion by the displacement of the LT usually occurs during the first 18-36 days [7], 30 days in our case. In the pseudoaneurysm of the superficial femoral artery the appearance of a pulsatile mass is frequent [8], but in the deep femoral artery cases, due to its anatomical location, it presents with more unspecific signs, such as swelling, edema, persistent pain and anemia, being able to be camouflaged by the typical hip surgery symptoms [9]. There are indirect radiographic signs that, accompanied by compatible clinical symptoms, should make us suspect the possible existence of a pseudoaneurysm, such as the medial and proximal displacement of the lesser trochanter or the medial displacement of the calcified femoral vessels, which is very representative in our case.…”

“…The particularity of the treatment performed is that we did not remove the shifted LT fragment. Other authors also performed endovascular treatments in cases of pseudoaneurysm due to displacement of the LT with satisfactory results without evidence of recurrence [1, 7, 8, 10]. The late onset of a pseudoaneurysm of the deep femoral artery or its branches is a rare complication after hip fractures, but it should be suspected in a clinical setting of persistent pain after nailing, together with the late onset of edema and hematoma in the thigh and indirect signs in radiographs, such as medial and superior displacement of the lesser trochanter or the calcified femoral vessels.…”