Secondary profunda femoris artery injury after intramedullary femoral nailing in a geriatric pertrochanteric femur fracture: case report

We present a case of a secondary injury to the femoral artery in a geriatric male patient who sustained a pertrochanteric femoral fracture. Six days after closed fracture reduction and intramedullary femoral nailing, the patient presented with persistent hematocrit level drops, femoral swelling and pain. A computed tomography angiography of the femur revealed a perforation of the profunda femoris artery through the dislocated lesser trochanter fragment, and immediate surgical revision was induced. The patient returned to his pre-injury mobilization level without any peripheral vascular or neurological deficiencies. A literature review suggests that the occurrence of vascular damage in proximal femoral fractures is rare but mainly presents in geriatric patients due to atherosclerosis and brittle bone mass.