Injury of a Branch of the Arteria Profunda Femoris after a Pertrochanteric Femur Fracture

Abstract

An 85-year-old patient suffered a pertrochanteric fracture of his left femur caused by a fall. He underwent osteosynthesis with a DYAX-nail on the day the accident took place. During his recovery an increasing dislocation of the lesser trochanter caused a violation of a branch of the arteria profunda femoris that required surgical intervention. The arterial lesion was treated by embolisation successfully. An arterial lesion due to a per- or subtrochanteric trauma that needs surgical intervention is extremely rare, iatrogenic arterial violations are described in up to 1 % during the transfemoral drilling procedure in order to fix common plate systems on the proximal femur. This case report establishes for the first time a bleeding complication caused by secondary dislocation of the lesser trochanter. In case of a per- to subtrochanteric fracture the biomechanical advantages of an intramedullary stabilisation add to the avoidance of transfemoral drilling in comparison to an extramedullary plate system fixed on the femoral shaft.

Pertrochanteric femur fracture - Complication - Bleeding

References

• 1 Bertelink B P, Stapert J W, Vierhout P A. The dynamic hip screw in medial fractures of the femoral neck: results in 51 patients.  Ned-Tijdschr-Geneeskd. 1993;  137 81-85
• 2 Bindewald H, Ruf W, Heger W. Die Verletzung der Iliacal- und Femoralgefäße - eine lebensbedrohliche Notfallsituation in der Hüftprothesenchirurgie.  Chirurg. 1987;  58 732-737
• 3 Broos P LO, Janzing H MJ, Reynders P, Vanderschot P, DeGreef I, Founeau I. Unstable pertrochanteric fractures - Twenty years of experience at the Katholieke Universiteit Leuven.  Osteosynthese International. 2000;  8 177-185
• 4 Eggert A, Huland H. Gefäßverletzungen und Osteosynthesen am proximalen Femurschaft.  Zbl Chir. 1977;  99 946-950
• 5 Fruhwirt J, Koch G, Ivanic G M, Seibert F J, Tesch N P. Gefäßläsionen in der Hüftgelenkchirurgie.  Unfallchirurg. 1997;  100 119-123
• 6 Garnavos C, Peterman A, Howard P W. The treatment of difficult proximal femoral fractures with the Russel-Taylor reconstruction nail.  Injury. 1999;  30 407-415
• 7 Hampton O P. Complications of common fractures. In: Artz CP, Hardy JD (eds). Complications in surgery and their management. WB Saunders Company, Philadelphia, London 1967
• 8 Hoffmeister A W. Arterienverletzungen in der Hüftgelenkendoprothetik.  Chirurgische Praxis. 1994;  48 99-104
• 9 Iannacone W M, Taffet R, DeLong W G, Born C T, Dalsey R M, Deutsch L S. Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation.  J Trauma. 1994;  37 446-451
• 10 Manner M, Rösch B, Roy K. Gefäßverletzungen bei Osteosynthesen proximaler Femurfrakturen.  Unfallchirurg. 1999;  102 227-231
• 11 Meeder P J, Buhl K, Müller S. Der PFN - Kritische Analyse nach 100 Implantationen.  Osteosynthese International. 1999;  7 (Suppl 2) 45-46
• 12 Nachbur B, Meyer R P, Baumgartner J. Vaskuläre Komplikationen in der Hüftgelenkchirurgie.  Orthopäde. 1989;  18 552-558
• 13 Paul M A, Patka P, van Heuzen E P, Koomen A R, Rauwerda J. Vascular injury from external fixation: case reports.  J Trauma. 1992;  33 917-920
• 14 Piltz S, Lob G. Komplikationen in der Unfallchirurgie.  Unfallchirurg. 1998;  101 856-865
• 15 Rapp M, Dittel K K, Eberhard H J, Miller W O. Eine innovative Methode zur Stabilisierung instabiler intertrochantärer Umkehrfrakturen des proximalen Femur (31A3.3).  Osteosynthese International. 1999;  7 (Suppl 2) 47-51
• 16 Rischke B, Westermann K, Mertens R. Der Gamma-Nagel als Standardverfahren bei der Versorgung trochanterer Oberschenkelfrakturen.  Osteosynthese International. 1999;  7 133-143
• 17 Schätzler A, Heilberger P, Möllers M, Stedtfeld H W, Raithel D. Arterielle Gefäßläsionen nach totalem Hüftgelenkersatz.  Unfallchirurg. 1997;  100 531-535
• 18 Vollmar J. Knochenbruch und Gefäßverletzung.  Langenbecks Arch Chir. 1975;  339 473-477