Lee Paul Y F, Rao Pathi V R, Golding David M, Brock James
South Wales Orthopaedic Research Network, Cardiff, South Wales, United Kingdom.
Princess of Wales Hospital, Bridgend, South Wales, United Kingdom.
JBJS Case Connect. 2017 Jul-Sep;7(3):e60. doi: 10.2106/JBJS.CC.16.00217.
A 75-year-old man underwent intramedullary nailing for an unstable intertrochanteric fracture of the left hip. After surgery and postoperative recovery, he was transferred to a rehabilitation ward. He was able to mobilize at 2 days postoperatively; at 2 weeks postoperatively, he developed the sudden onset of tachycardia, hypotension, and a large hematoma on the left thigh. Following immediate resuscitation, a computed tomography (CT) angiogram demonstrated a bleed from a branch of the profunda femoris artery. The 3-dimensional CT reconstruction implicated the displaced lesser trochanter osseous fragment as the cause of the hemorrhage.
Surgeons should be aware of this rare complication and the possible etiology of fracture displacement as the cause of a delayed-onset bleed after intramedullary nailing, and they should also be cognizant of the subsequent optimal management.
