Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail

Iatrogenic vascular injuries are uncommon during the course of proximal femur surgical procedures. We report the case of an 85-year-old female presenting with an intertrochanteric fracture, treated by anterograde (cephalocondylic) intramedullary nailing (Stryker gamma 3 (TM) nail) and complicated by a superficial femoral artery laceration at the level of the distal locking screw. Lower limb traction in adduction and internal rotation on the operating table might put at risk the superficial femoral artery during distal screw drilling and insertion. We therefore recommend returning to the neutral position and reducing lower extremity traction after femoral head screw placing and before final distal screw insertion. This technical precaution should limit the risk of superficial femoral artery injury associated with short-nail anterograde intramedullary nailing. Type of study: Level IV retrospective. (C) 2009 Elsevier Masson SAS. All rights reserved.