#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Injuries to Femoral Vessels after Fracture of the Hip


Authors: J. Bartoníček
Authors‘ workplace: Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha-Vinohrady přednosta: prof. MUDr. Jan Bartoníček, DrSc.
Published in: Rozhl. Chir., 2009, roč. 88, č. 4, s. 203-205.
Category: Monothematic special - Original

Overview

Injury to femoral vessels in trochanteric fractures is a rare but a severe complication. Most often it involves the profunda femoris artery, less often the (superficial) femoral artery. This injury may be caused by different mechanisms; most frequently by pressure of a sharp bone fragment (the lesser trochanter), the tip of protruding cortical screws (extramedullary implant) or the distal locking screw (Gamma nail). Less often it is caused by the drill bit or incorrectly placed elevators. Pressure of a sharp bone fragment or contact with protruding tips of screws results in a gradual erosion of vessels and consequently in development of false aneurysm. Sometimes this defect may become evident as late as several weeks or years after operation. Typical of acute bleeding is tachycardia, hypotension, rapid hematocrite decrease, rapid swelling of the thigh with palpable pulsation and pain. It may be associated also with an audible bruit. In the gradually developed false pseudoanerysm, there dominates a slowly growing swelling and increasing pain. Diagnosis and localization of vascular lesion may be performed using duplex ultrasonography, CT, CT contrast angiography, conventional angiography and MRI. Differential diagnosis should be used to eliminate deep venous thrombosis and sarcoma of soft tissues with bleeding into tumour. Treatment of injury to the profunda femoris artery depends on the condition of the (superficialis) femoral artery. If this artery is not blocked, it is possible to perform embolization or ligation of the profunda femoris artery. Where the superficial femoral artery is obstructed, for instance due to arteriosclerosis, the (superficialis) femoral artery or the profunda femoris artery must be reconstructed. Injury to the (superficial) femoral artery is best treated by its reconstruction.

Key words:
hip fractures – vascular lesions – false aneurysm


Sources

1. Abraham, E., Pankovich, A. M., Jansey, F. False aneurysm of the profunda femoris artery resulting from intertrochanteric fracture. J. Bone Joint Surg. Am., 1975, 57-A, 871.

2. Bernstein, I., Geks, J., Walthers, E. M., Schnabel, M. Aneurysma spurium und verzögerte Blutungskomplikation durch ein sekundär disloziertes Trochanter-minor-Fragment bei pertrochantärer Femurfraktur. Unfallchirurg, 2004, 107, 1192–1195.

3. Dameron, T. B. False aneurysm of femoral profundus artery resulting from internal-fixation device (screw). J. Bone Joint Surg. Am., 1964, 46-A, 577–580.

4. Fordyce, A. False aneurysm of the profunda femoris artery following nail and plate fixation on an intertrochanteric fracture. J. Bone Joint Surg. Br., 1968, 50-B, 141–143.

5. Karkos, C. D., Hughes, R., Prasad, V., D’Souza, S. P. Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture. J. Trauma, 1999, 47, 393–395.

6. Laohapoonrungsee, A., Sirirungruangsarn, Y. Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: Two cases report. J. Med. Assoc. Thai., 2005, 11, 1703–1706.

7. Mauerhan, D. R., Maurer, R. C., Effeney, D. Profunda femoris arterial laceration secondary to intertrochanteric hip fracture fragments. Clin. Orthop., 1981, 161, 215–219.

8. Ryzewicz, M., Robinson, M., Mc Connell, J., Lindeque, B. Vascular injury during fixation of an intertrochanteric hip fracture in a paitnet with severe atherosclerosis. J. Bone Joint Surg. Am., 2006, 88-A, 2483–2486.

9. Soballe, K., Christensen, F. Laceration of the superficial femoral artery by an intertrochanteric fracture fragment. A case report. J. Bone Joint Surg. Am., 1987, 69-A, 781–783.

10. Storm, R. K., Sing, A. K., de Graaf, E. J. R., Tetteroo, G. W. Iatrogenic arterial trauma associated with hip fracture treatment. J. Trauma, 2000, 48, 957–959.

11. Whitehill, R., Wang, G. J., Edwards, J. R., Stamp, W. G. Late injuries to femoral vessels after fracture of the hip. Case report. J. Bone Joint Surg. Am., 1978, 60-A, 541–542.

12. Wolfgang, G. L., Barnes, W. T., Hendricks, G. L. False aneurysm of the profunda femoris artery resulting from nail-plate fixation of intertrochanteric fracture. A case report and review of the literature. Clin. Orthop., 1974, 100, 143–150.

13. Yang, K. H., Park, H. W., Park, S. J. Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: Report of a case. J. Orthop. Trauma, 2002, 16, 124–127.

Labels
Surgery Orthopaedics Trauma surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#