Femoral arteriovenous fistula associated with surgery of proximal femoral fracture: a systematic review of the literature and case presentation

Late deep femoral artery injury after intertrochanteric hip fracture treatment: A case report

INTRODUCTION AND IMPORTANCE

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.

CASE PRESENTATION

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.

CLINICAL DISCUSSION

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.

CONCLUSION

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.

Enterocutaneous fistula formation thirty years after a femoral neck fracture fixation with lag screws: A case report

INTRODUCTION AND IMPORTANCE

As the population grows older, femoral neck fracture is becoming one of the prevalent cases in orthopedics, although this fracture can also happen in younger individuals following high energy traumas. Fixation with cancellous lag screws is one treatment option for femoral neck fractures, especially for young adults and relatively active older patients.

CASE PRESENTATION

In this case report, we describe a 52-year-old man referred with the formation of enterocutaneous fistula (ECF) in the surgery place for fixation of a femoral neck fracture 30 years prior to presentation.

CLINICAL DISCUSSION

Interpretation of CT scan images as well as findings of the performed laparotomy suggested that fixation procedure with screws was probably the main culprit for penetration of ileum. Subsequently, the removal of screws enabled the fistula to reach the surface of skin, which presented with fecal drainage. To eliminate fistula, we performed right hemicolectomy and ileocolic anastomosis for the case.

CONCLUSION

Since management of ECF remains among the most challenging problems for surgeons, this unique case report indicates the possibility for formation of such fistula following a fixation procedure in the hip joint area, even after thirty years and stresses on taking measures in order to prevent fistula formation caused by the prevalent procedures performed on the hip joint.