PMC6083593_01
Preoperative (a) and immediate postoperative (b) radiographs show stable intertrochanteric fracture without comminution, acceptable reduction, and good positioning of the nail and screws.
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X-rays and computed tomography (CT) of the painful hip showed a femoral trochanteric fracture with an Evans classification of 1c (Figure 1(a)). Two days after injury, the patient underwent internal fixation with an intramedullary nail via the lateral approach with gentle traction, internal rotation, and adduction using a traction table (Figure 1(b)).
(a) Swelling of the affected limbs. (b, c) Magnetic resonance imaging shows pseudoaneurysms (arrow) and huge hematoma (arrowhead). (d) Computed tomography angiographies with a 3-dimensional reconstruction view demonstrate pseudoaneurysms (arrowhead).
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We noticed warmth and subcutaneous bleeding in the left femoral region and suspected an arterial injury due to the surgery (Figure 2(a)). On magnetic resonance imaging (MRI), a huge hematoma was detected in the left inner femoral region (Figures 2(b) and 2(c)). On CT angiography, a pseudoaneurysm was detected near the tip of the cortical screws at the distal site (Figure 2(d)).
(a) Angiogram demonstrates a pseudoaneurysm of a branch of the profunda femoris artery. (b) Angiogram following endovascular coil embolization (arrow). The angiogram shows no filling of the pseudoaneurysm near the screw.
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After conducting angiography, vascular leakage from a deep femoral artery branch was confirmed (Figure 3(a)). The vascular lesion was immediately treated by transcatheter embolization, and the vascular leakage was completely resolved with catheter embolization (Figure 3(b)).
Graph illustrating Hb and CRP levels on consecutive postoperative days.
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After embolization, the patient's clinical state improved rapidly, and the Hb and C-reactive protein (CRP) values improved to normal after several weeks (Figure 4).