Thrombosis of the Superficial Femoral Artery following Fixation of Intertrochanteric Fracture of the Femur using a Dynamic Hip Screw.

Abstract

Introduction:Vascular injuries in orthopedic surgery are relatively rare but potentially limb and life threatening. They are most commonly encountered in knee and hip arthroplasty but also have been reported in trauma surgeries. Pertrochanteric fractures of proximal femur are among the most common fractures encountered in elderly osteoporotic patients. Positioning on fracture table, traction, and reduction maneuvers employed during fixation of these fractures, place the vessels at risk by bringing them closer to the bone. Iatrogenic vascular injuries can occur if adequate care is not taken during instrumentation for fracture fixation.Case Report:We are reporting a case of 62 years female who underwent fixation of an intertrochanteric fracture of femur using a dynamic hip screw (DHS) and subsequently started developing ischemic changes in the operated lower limb on the 3rd post-operative day. Angiography revealed thrombosis of the superficial femoral artery at the level of the third screw of the DHS and the patient ultimately landed up with an amputation.Conclusion:Operating surgeon should be aware of the risk of iatrogenic vascular injury during fixation of pertrochanteric fractures. Good surgical technique and simple precautionary measures can minimize the risk of this devastating complication.