Başak Furkan, Ardalı Deniz, Candan Emre Sırrı, Taşcı Murat, Söylemez U Percem Orhan, Söylemez Mehmet Salih
Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
Department of Radiology, Göztepe City Hospital, Division of Interventional Radiology, Istanbul, Turkey.
J Orthop Case Rep. 2024 Oct;14(10):153-157. doi: 10.13107/jocr.2024.v14.i10.4844.
Superior gluteal artery (SGA) injury is an uncommon, yet critical complication associated with trochanteric fracture surgery. While deep femoral artery branches are more frequently affected, SGA involvement is infrequent but potentially life threatening. Knowledge of anatomy plays a crucial role in reducing the likelihood of such complications. Factors contributing to deep femoral artery injury include direct trauma from fracture fragments, excessive drilling, or inadvertent arterial damage during instrumentation. To date, only a few cases have reported SGA injuries following trochanteric fracture surgery. In this study, we report a late presented SGA pseudoaneurysm after intramedullary nailing of intertrochanteric fracture.
A 72-year-old female with a right intertrochanteric fracture underwent surgery involving the placement of a short cephalomedullary nail. In the 3rd week postoperatively, the patient presented with a sizable hematoma near the proximal and posterior section of the incision. Subsequent investigations unveiled a pseudoaneurysm in the SGA as the source of the hematoma and declining hemoglobin levels. The pseudoaneurysm was successfully treated with embolization, and the patient recovered without complications.
Prompt recognition of post-operative hemoglobin decrease, regardless of clinical symptoms, is essential. Computed tomography angiography is valuable for early detection and intervention of SGA injuries. Surgeons must be careful when opening the incision and determining the entry point, as anterior incision and medialized guidewire may increase the risk of SGA injury. Awareness of this rare complication and its management is vital to prevent possible complications.
臀上动脉（SGA）损伤是一种与转子间骨折手术相关的罕见但严重的并发症。虽然股深动脉分支更常受累，但SGA受累情况不常见，但可能危及生命。解剖学知识在降低此类并发症的可能性方面起着至关重要的作用。导致股深动脉损伤的因素包括骨折碎片的直接创伤、过度钻孔或器械操作过程中意外的动脉损伤。迄今为止，仅有少数病例报道了转子间骨折手术后的SGA损伤。在本研究中，我们报告了1例转子间骨折髓内钉固定术后迟发性出现的SGA假性动脉瘤。
一名72岁的女性因右转子间骨折接受了短头髓内钉置入手术。术后第3周，患者在切口近端和后部附近出现了一个较大的血肿。随后的检查发现SGA存在假性动脉瘤，为血肿的来源，且血红蛋白水平下降。该假性动脉瘤通过栓塞成功治疗，患者康复且无并发症。
无论有无临床症状，及时识别术后血红蛋白下降至关重要。计算机断层血管造影对于SGA损伤的早期检测和干预很有价值。外科医生在切开切口和确定进针点时必须小心，因为前侧切口和导丝内移可能会增加SGA损伤的风险。认识到这种罕见并发症及其处理方法对于预防可能的并发症至关重要。
