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Case Reports
. 2024 Oct;52(10):300060519892381.
doi: 10.1177/0300060519892381. Epub 2019 Dec 18.

Pseudoaneurysm of the internal iliac artery caused by proximal femoral nail antirotation following intertrochanteric fracture: a case report

Cheng Ren  1 , Qian Wang  1 , Teng Ma  1 , Zhong Li  1 , Huijun Yuan  2 , Yan Huang  2 , Hanzhong Xue  1 , Kun Zhang  1
Affiliations
Case Reports

Pseudoaneurysm of the internal iliac artery caused by proximal femoral nail antirotation following intertrochanteric fracture: a case report

Cheng Ren et al. J Int Med Res. 2024 Oct.

Abstract

Pseudoaneurysm of the internal iliac artery is a very rare complication of intertrochanteric fracture. Here, the case of an 88-year-old female patient, who presented with intense pain following surgery for intertrochanteric fracture of the femur, is reported. Radiography revealed intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA was found to have disassembled, and the screw had penetrated through the acetabulum. As computed tomography (CT) revealed a haematoma behind the acetabulum, CT angiography was immediately performed. A pseudoaneurysm of the internal iliac artery caused by PFNA was revealed. Percutaneous endovascular treatment of the pseudoaneurysm was undertaken on an urgent basis. Three days later, the PFNA was removed, and the fracture was reduced and fixed with locking proximal femoral plate. The patient's pain was significantly reduced following this corrective surgery. This case illustrates that substandard PFNA surgery for intertrochanteric fracture may result in pseudoaneurysm of the internal iliac artery.

Keywords: Pseudoaneurysm; femur intertrochanteric fracture; internal iliac artery; proximal femoral nail antirotation.

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Figures

Figure 1.
Figure 1.
Plain radiograph showing intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA had become disassembled, and the PFNA screw blade had penetrated through the acetabulum.
Figure 2.
Figure 2.
Computed tomography angiography image that was immediately obtained following the discovery of a haematoma behind the acetabulum, showing pseudoaneurysm of the internal iliac artery caused by the screw blade of the proximal femoral nail antirotation.
Figure 3.
Figure 3.
Radiography image showing extravasation of contrast agent in the internal iliac artery.
Figure 4.
Figure 4.
Radiography image showing successful coil embolization of the feeding arteries, with no visible extravasation of the contrast agent.
Figure 5.
Figure 5.
Plain radiograph showing that the proximal femoral nail antirotation had been removed, and the fracture was reduced and fixed with locking proximal femoral plate. Surgical treatment included the addition of the anterior limited contact locking compression plate (LC-LCP) due to poor bone mass.
See this image and copyright information in PMC

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