PMC4906138_01
Displaced intertrochanteric femoral fractures on the right side with medial dislocation of a sharp lesser trochanter fragment in an 81 year-old man.
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The X-rays of the painful hip showed an intertrochanteric fracture with medial dislocation of a sharp lesser trochanter fragment (Fig. 1).
The intraoperative X-ray of the hip showed a stable fixation of the fracture.
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The surgical procedure was performed without intraoperative complications and without further displacement of the lesser trochanter that remained in the same position (Fig. 2).
The angio-CT with 3D reconstruction of the operated thigh, performed 42 h after surgery for persistent signs of acute bleeding, showed an active extravasation from a complete rupture of a branch of the profunda femoris artery adjacent to the spike of the displaced lesser trochanter.
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Therefore, we stopped the antithromboembolic therapy and the patient had an angio-CT with 3D reconstruction that showed an active extravasation from a complete rupture of a branch of the profunda femoris artery adjacent to the spike of the displaced lesser trochanter (Fig. 3).
The arteriography performed during the endovascular procedure, confirmed the active bleeding from the branch of the profunda femoral artery (A). After transcatheter embolization, the bleeding was completely blocked (B).
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The endovascular procedure blocked the bleeding completely (Fig. 4A and B) and the patient had rapid clinical improvement, with a stable value of haemoglobin that rose to normal values in a few weeks.
Six months after the operation, the X-rays of the hip showed complete healing of the fracture. The endovascular device was quite visible below the lesser trochanter.
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The patient was followed up regularly for 6 months until complete clinical and radiographic healing of the fracture (Fig. 5).