Samaan Michel, Idres Fatima Abdulmoain, Hawa Yacin, Madania Marwa
Al-Baath University, Faculty of Medicine, Homs, Syria; Syrian Association of Arthroscopy, Damascus, Syria.
Al-Baath University, Faculty of Medicine, Homs, Syria.
Int J Surg Case Rep. 2023 Apr;105:107983. doi: 10.1016/j.ijscr.2023.107983. Epub 2023 Mar 17.
Arterial injury is a rare complication following hip fracture surgery. If not diagnosed appropriately, can lead to life- or limb-threatening situations. This report describes a case of late iatrogenic arterial injury, four weeks following surgery for intertrochanteric fracture.
An 89-year-old woman suffered an intertrochanteric fracture. The deep femoral artery was injured four weeks after fracture treatment by dynamic hip screw, following increase of range of motion during the rehabilitation exercises. Pain and swelling increased markedly at the thigh. Slight fever with no tachycardia and the deceptive laboratory tests directed us to late-appearing sepsis. A color Doppler ultrasonography examination did not identify the arterial bleeding. Treatment was carried out to evacuate the presumed pus, but big clots were seen instead, and an active arterial bleeding was discovered. The arterial lesion was sutured and hemodynamic stability was restored.
The appearance of injury may be either acute or delayed. Unexplained laboratory results, use of beta-blockers and non-classical symptoms may be obstacles to early diagnosis of arterial injury.
A high index of clinical suspicion of arterial injury, even after long period after surgery, should be kept in mind. More precise investigations may be needed, as angiography, for making the diagnosis of arterial injury.
动脉损伤是髋部骨折手术后一种罕见的并发症。若未得到恰当诊断，可能导致危及生命或肢体的情况。本报告描述了一例转子间骨折手术后四周发生的迟发性医源性动脉损伤病例。
一名89岁女性发生转子间骨折。在采用动力髋螺钉治疗骨折四周后，因康复锻炼期间活动范围增加，股深动脉受损。大腿疼痛和肿胀明显加剧。伴有低热但无心动过速，且实验室检查结果具有迷惑性，这些情况使我们最初误诊为迟发性脓毒症。彩色多普勒超声检查未发现动脉出血。进行了穿刺引流以排出推测的脓液，但却发现了大血块，并发现存在活动性动脉出血。对动脉病变进行了缝合，血流动力学恢复稳定。
损伤表现可能是急性的，也可能是延迟性的。无法解释的实验室检查结果、使用β受体阻滞剂以及非典型症状可能是动脉损伤早期诊断的障碍。
即使在手术后很长时间，也应高度怀疑动脉损伤。可能需要进行更精确的检查，如血管造影，以诊断动脉损伤。
