Late deep femoral artery injury after intertrochanteric hip fracture treatment: A case report

INTRODUCTION AND IMPORTANCE: Arterial injury is a rare complication following hip fracture surgery. If not diagnosed appropriately, can lead to life- or limb-threatening situations. This report describes a case of late iatrogenic arterial injury, four weeks following surgery for intertrochanteric fracture. CASE PRESENTATION: An 89-year-old woman suffered an intertrochanteric fracture. The deep femoral artery was injured four weeks after fracture treatment by dynamic hip screw, following increase of range of motion during the rehabilitation exercises. Pain and swelling increased markedly at the thigh. Slight fever with no tachycardia and the deceptive laboratory tests directed us to late-appearing sepsis. A color Doppler ultrasonography examination did not identify the arterial bleeding. Treatment was carried out to evacuate the presumed pus, but big clots were seen instead, and an active arterial bleeding was discovered. The arterial lesion was sutured and hemodynamic stability was restored. CLINICAL DISCUSSION: The appearance of injury may be either acute or delayed. Unexplained laboratory results, use of beta-blockers and non-classical symptoms may be obstacles to early diagnosis of arterial injury. CONCLUSION: A high index of clinical suspicion of arterial injury, even after long period after surgery, should be kept in mind. More precise investigations may be needed, as angiography, for making the diagnosis of arterial injury.