Delayed Profunda Femoris Artery Bleeding After Intramedullary Nailing of an Unstable Intertrochanteric Fracture: A Case Report

Profunda Femoris Pseudoaneurysm and Fatal Hemorrhage 2 Weeks After Modified Girdlestone Resection Arthroplasty: A Case Report

CASE

A 62-year-old nonambulatory female patient presented with wound dehiscence and purulent bloody drainage 2 weeks after modified Girdlestone resection arthroplasty for subtrochanteric femur fracture. On developing an enlarging thigh hematoma and hemodynamic instability, the patient was taken to the vascular suite where a profunda femoris artery pseudoaneurysm was identified and ligated by the vascular surgery team. The proximal free edge of the resected femur was determined to be the likely cause of arterial injury. Two days later, the patient was taken by the orthopaedic surgery team for debridement and revision resection arthroplasty, but she ultimately decompensated and died.

CONCLUSION

We believe this to be the first reported case of this serious complication of the Girdlestone procedure. We hope this case helps bring awareness to the complication and aids in early detection and prompt treatment of femoral artery complications.

Trochanter migrans: late complications due to displacement of the lesser trochanter in trochanteric fractures

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.

When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review

Purpose

To systematically evaluate the benefits of reducing and fixing displaced lesser trochanter (LT) of trochanteric fractures and when this procedure is worth the effect.

Methods

From database establishment through March 2021, four online databases (PubMed, Cochrane, Embase, and Web of Science) were searched for relevant literature that investigated reduction and fixation for displaced LT of trochanteric fractures. The papers were then screened by two reviewers independently and in duplicate according to prior inclusion and exclusion criteria. Demographic data as well as data on fracture types, surgical protocols, and surgical outcomes were recorded, analyzed, and interpreted.

Results

Total 10 clinical studies with 928 patients were included, in which 48 cases had intact LT and 880 cases involved the displaced LT, of which 196 (22.27%) cases underwent reduction and fixation for LT while the rest of 684 (77.73%) cases not. In these studies, complications were evaluated as a more applicable predictive parameter for operation than postoperative hip function.

Conclusion

It was beneficial to reduce and fix the displaced LT when one of the conditions below occurred: displacement distance of LT ≥2 cm, quantity of comminuted LT fragments ≥2, and range of LT fragments in medial wall ≥75%; the fracture line of LT fragments reaching or exceeding the midline of the posterior wall.

[Injury of the profunda femoris artery with bleeding requiring transfusion due to secondary dislocation of the lesser trochanter after osteosynthesis of an intertrochanteric femoral fracture]

Ein 95-jähriger Patient erlitt eine transfusionspflichtige Blutung nach Osteosynthese einer pertrochantären Femurfraktur mittels proximalem Femurnagel. Das bei der Erstmobilisation sekundär dislozierte Fragment des Trochanter minor perforierte einen Seitenast der A. profunda femoris. Die Blutung konnte mittels Embolisation gestillt werden, und der Patient wurde wenige Tage später mit stabilem Hämoglobinwert entlassen. Wiederholt sinkende Hämoglobinwerte trotz mehrmaliger Bluttransfusion weisen auf eine aktive Blutung hin. Die genaue Identifikation der Blutungsquelle nach Osteosynthese proximaler Femurfrakturen ist entscheidend für die korrekte Therapie.