# Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review

## TL;DR

This paper reports a rare but severe vascular injury after hip fracture surgery and emphasizes the importance of early diagnosis and collaboration between specialists.

## Contribution

The paper presents a rare case of deep femoral artery injury caused by over-drilling during DHS osteosynthesis and updates the literature on vascular complications.

## Key findings

- A 77-year-old patient developed a deep femoral artery injury after DHS osteosynthesis due to over-drilling.
- CT angiography identified the injury at the level of the most distal screw in the profunda femoris artery.
- Early diagnosis and interdisciplinary collaboration led to a favorable outcome in this case.

## Abstract

Background and Clinical Significance: Vascular complications occurring in the context of trans-trochanteric fractures are rare (mean incidence 0.2–0.5%) but can be fatal if not recognized and treated promptly. Most of the previously reported vascular injuries are iatrogenic, and various mechanisms of injury and producing agents have been reported. Case Presentation: We present a rare but severe vascular complication following proximal femur fracture fixation in the case of a 77-year-old patient, specifically, a deep femoral artery injury after DHS osteosynthesis. CT angiography identified the lesion in the territory of the profunda femoris artery, precisely at the level of the most distal screw, suggesting over-drilling as the underlying cause. The case is presented in the context of a literature review, updating the most important features of the vascular complications, incidence, diagnosis and treatment. Conclusions: This case highlights the critical role of early diagnosis and prompt interdisciplinary collaboration between orthopedic and vascular surgeons in managing iatrogenic vascular complications, achieving a favorable outcome.