Pseudoaneurysm of the Superficial Femoral Artery After Closed Hip Nailing With a Gamma Nail: Report of a Case

Abstract

Pseudoaneurysm of the femoral artery after internal fixation of a trochanteric fracture is caused primarily by overpenetration of the drill bit or screws. We report a case of pseudoaneurysm of the superficial femoral artery after insertion of a Gamma nail. A probable cause for this injury is adduction and internal rotation of the involved limb. During the distal interlocking procedure, this maneuver endangers the superficial femoral artery by abutment of the femoral vessels to the femur. It is recommended that the limb be placed in a neutral position during preparation of the interlocking hole.

Late Presentation of an Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery following Intramedullary Nailing

“…Avulsion of the lesser trochanter leads to an increased risk of femoral vessel damage caused by a displaced bone spike [4]. Iatrogenic vascular injury can be caused either by the use of retractors, by drilling the distal locking hole, or by protrusion of the distal locking screw through the medial femoral cortex [3, 6–8]. Pseudoaneurysms or false aneurysms are caused by partial arterial vessel damage with subsequent formation of a hematoma that is in contact with the arterial lumen.…”

“…This may be iatrogenic or less frequently a result of the fracture itself, caused by vessel damage secondary to sharp bony fragments [4]. Iatrogenic vascular injury can be caused by either the use of retractors [5], drilling the distal locking hole, or protrusion of the distal locking screw through the medial femoral cortex [3, 6–8]. Profunda femoris artery (PFA) damage, injury of the superficial femoral artery (SFA), or their perforating branches can cause acute hemorrhage, pseudoaneurysms, or compartment syndrome and may require vascular surgery [4, 9].…”

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

“…In addition to injuries to profunda femoris, the superior gluteal and superficial femoral arteries are commonly reported as at risk of injury [1][2][3][4][5][6]. Typically during the placement of the third or fourth distal screw of a compression plate or through guide wire penetration when locating the trochanteric entry point, these vessels may also present with acute or sub-acute symptoms, though are seldom associated with displacement of fracture fragments.…”

“…The evolution of intramedullary fixation methods for neck of femur fractures has resulted in a small cohort of reported vascular complications; typically these have been associated with the distal anterior-posterior locking screws and thus penetration of the superficial femoral artery [1]. Indeed, cadaveric studies have investigated the anatomical variations of the superficial femoral vessels and outlined strategies to avoid inadvertent injury during distal locking [5].…”

Unusual Presentation of Pseudoaneurysm with Trochanteric Fracture Femur with Associated Long-Term Antiepileptic Therapy

“…Arterial injuries in the vicinity of proximal femur have been reported after total hip replacement, DHS fixation [1, 2], nail-plate fixation [3, 4], external fixation, and gamma nailing [5, 6] for proximal femoral fractures. An arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been rarely documented [5, 7–10].…”