Injury of the profunda femoris artery with bleeding requiring transfusion due to secondary dislocation of the lesser trochanter after osteosynthesis of an intertrochanteric femoral fracture

Abstract

A 95-year-old patient suffered bleeding that required a transfusion after closed reduction and internal fixation (CRIF) of an intertrochanteric femoral fracture with a proximal femoral nail. After mobilization of the patient the secondarily dislocated fragment of the lesser trochanter perforated a side branch of the profunda femoris artery. The bleeding could be stopped by embolization and a few days later the patient could be discharged with stable hemoglobin levels. A continuing decrease of hemoglobin levels despite repeated transfusion of red blood cells is indicative of active bleeding. Accurate identification of the source of the bleeding after osteosynthesis of proximal femoral fractures is decisive for the correct treatment.