Delayed hematoma in gluteus medius caused by Gamma nail protrusion over the greater trochanter

Abstract

Aside from cases of mechanical complications or infection short femoral nails (SFNs) are not removed after open reduction and internal fixation (ORIF) because femoral trochanteric fractures often occur in older osteoporotic females. Occasionally, SFN removal is performed because of severe chronic hip and thigh pain after surgery. However, cases of large hematoma formation in the gluteus medius with associated severe pain have not been reported in patients after ORIF.A 58-year-old healthy woman fell and incurred a femoral trochanteric fracture at work. ORIF was performed using Gamma nail for the fracture, which was classified as AO31-1.2 according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification. The bone healed sufficiently. The patient reported chronic hip and thigh pain after ORIF, but the SFN was not removed because of concerns about further fractures. After 1 year and 8 months, she suddenly experienced severe hip and thigh pain with hip swelling, but without prior trauma. Magnetic resonance imaging (MRI) showed a large hematoma in the gluteus medius near the greater trochanter. Under general anesthesia, SFN removal was performed because of the persistent pain. After SFN removal, the chronic pain resolved without any complications, such as a femoral neck fracture.In this case, chronic hip and thigh pain and delayed hematoma may have been caused by SFN protrusion over the greater trochanter, damaging soft tissues around the gluteus medius. Thus, soft tissue injury and hematoma are possible in patients with chronic hip and thigh pain after ORIF using SFN. In using SFN for femoral trochanteric fractures, it is important to prevent protrusion of SFN over the greater trochanter. Further careful follow-up with MRI and/or ultrasonography is needed to study delayed hematoma after ORIF using SFN.