Profunda femoris injury following lesser trochanter displacement: Complications following intramedullary femoral nailing

Lesser Trochanter Migration following Intramedullary Fixation of an Intertrochanteric Femur Fracture

“…There was a substantial delay between the presentation of groin pain and the diagnosis of dislocation of the lesser trochanter to the femoral triangle. As pointed out in previous case reports [ 1 , 2 , 4 , 5 ], this may have determined further life-threatening complications such as femoral artery bleeding. It is often the case that elderly patients treated for pertrochanteric hip fractures are transferred to rehabilitation facilities postoperatively.…”

“…These complications have been observed both preoperatively [ 2 , 3 ] and after intramedullary fixation [ 1 , 4 , 5 ]. Four of these cases [ 1 , 2 , 4 , 5 ] presented with either deep or superficial femoral artery injury, while one case [ 3 ] presented with femoral nerve palsy. The present study reports the first case of postoperative lesser trochanter cephalad migration manifesting as a subcutaneous painful groin mass and neurovascularly intact lower extremity.…”

Superior gluteal artery pseudoaneurysm following intramedullary nailing of an atypical femoral fracture

“…Vascular complications related to orthopaedic hip fracture surgery are rare, with studies reporting an overall incidence of about 0.2% 5 6. Of the reported cases, the majority of the iatrogenic injuries related to intramedullary femoral nailing involve branches of the profunda femoris artery 5–10.…”

“…Vascular complications related to orthopaedic hip fracture surgery are rare, with studies reporting an overall incidence of about 0.2% 5 6. Of the reported cases, the majority of the iatrogenic injuries related to intramedullary femoral nailing involve branches of the profunda femoris artery 5–10. Due to the proximity of the profunda femoris artery to the placement of the intramedullary femoral nail, the most common mechanism of injury is penetration of the vessel by a drill, retractor or screw 9 10.…”

“…This subsequently results in either acute onset of intraoperative haemorrhage or pseudoaneurysm formation with delayed onset bleeding 8. There have also been reports of profunda femoris artery injury due to displaced fracture fragments secondary to iliopsoas muscle contraction during manipulation of the patient 5 11…”