Profunda Femoris Artery Pseudoaneurysm After Proximal Nailing: A Case Report

TL;DR

A 68-year-old man developed a rare artery injury after hip fracture surgery, requiring combined orthopedic and vascular treatment.

Contribution

Highlights profunda femoris artery pseudoaneurysm as a rare complication of hip fracture fixation and secondary trauma.

Findings

Computed tomography confirmed a pseudoaneurysm caused by a displaced bone fragment.

Combined orthopedic and vascular treatment led to successful recovery.

Early imaging and multidisciplinary care are crucial to prevent severe complications.

Abstract

Hip fractures in elderly patients are common after low-energy trauma, while vascular complications remain rare but potentially life-threatening. A pseudoaneurysm of the profunda femoris artery may occur when displaced bone fragments come into close contact with the vessel. We report the case of a 68-year-old man who sustained a displaced subtrochanteric fracture treated with gamma nail fixation. The initial postoperative course was uneventful; however, a secondary fall on postoperative day seven led to implant displacement, progressive anemia, and thigh swelling. Computed tomography angiography revealed a large profunda femoris artery pseudoaneurysm in direct contact with a displaced lesser trochanter fragment, confirming the causal role of this fragment. Management required a combined orthopedic and vascular approach, including fragment reduction and fixation, followed by endovascular stent placement. At the two-month follow-up, fracture union was achieved, and the patient regained pain-free mobility with crutches. This case highlights that vascular injury should be suspected in patients with persistent anemia or swelling after hip fracture fixation, particularly following secondary trauma, and emphasizes the importance of early vascular imaging and multidisciplinary management to prevent severe complications.

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