Arterial injury and pseudoaneurysm formation after lesser trochanter fracture

INTRODUCTION: Vascular complications after hip fracture are rare but can be life-threatening, especially in the elderly and if diagnosed late. PRESENTATION OF THE CASE: We report a false aneurysm of the calcified deep femoral artery after hip fracture and uneventful stabilization with a gamma nail, in an 85 year old woman. Three weeks after surgery there was swelling of the proximal thigh. Ultrasound scan revealed a false aneurysm of the deep femoral artery and plain X-ray showed a lesser trochanter fragment spiking the calcified deep femoral artery. Open repair of the pseudo-aneurysm with a vein patch was performed. DISCUSSION: Nowadays the preferred imaging of false aneurysms is by computed tomographic (CT) angiography but this involves high radiation and nephrotoxic contrast agents and may delay diagnosis. What made this a special case was the post-operative plain X-ray which showed a displaced fragment of the lesser trochanter spiking the calcified deep femoral artery, as confirmed on CT scanning. CONCLUSION: Surgeons should pay attention to any displaced bone fragments close to calcified vessels, especially in the evaluation of routine x-rays following surgical treatment of fractures. This could minimize the potential life-threatening risk of delayed diagnosis, especially because it represents a routine image following surgical fracture treatments.