Superior gluteal artery bleed after cephalomedullary nail fixation

Abstract

Background: Hip fracture is a common orthopedic condition that leads to many hospitalizations each year. Intertrochanteric femur fractures are commonly treated with cephalomedullary nail fixation. Superior gluteal artery bleed is a rare complication of cephalomedullary nail fixation, especially when the trochanteric approach is used. Case Report: A 63-year-old male presented to the emergency department with a right intertrochanteric femur fracture after a fall from standing height. Cephalomedullary nail fixation was performed without any complications during the operation. The patient’s postoperative course was complicated by decreasing hemoglobin levels despite blood transfusions. Superior gluteal artery bleed with a large hematoma was discovered on postoperative day 4. The bleed was embolized, and the patient was stabilized and discharged. Conclusion: We found only 1 published report of a superior gluteal artery bleed associated with nail placement. During the operative procedure, guidewire placement requires careful consideration because of the risk of vascular damage. Superior gluteal artery injury, although rare, should be considered in patients with unstable hemoglobin levels after nail placement.