Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture

Hyun Cheol Oh; Jae Wan Suh; Dae Kyung Kwak; Han Kook Yoon

doi:10.4055/jkoa.2013.48.3.240

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Oh, Suh, Kwak, and Yoon: Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture

Case Report

Journal of the Korean Orthopaedic Association 2013; 48(3): 240-245.

Published online: 24 June 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.3.240

Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture

Hyun Cheol Oh, M.D., Jae Wan Suh, M.D.^*, Dae Kyung Kwak, M.D.^*, Han Kook Yoon, M.D.

Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan, Korea.

^*Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Korea.

Correspondence to: Han Kook Yoon, M.D. Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea. TEL: +82-31-900-0540, FAX: +82-31-900-0343, hangugy@hanmail.net

Received 17 October 2012 Revised 19 February 2013 Accepted 22 March 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Interlocked intramedullary nailing is widely accepted for treatment of closed femoral shaft fractures. An interlocking screw is inserted percutaneously, and especially the distal screw is inserted without use of a guide. Vascular complications associated with an interlocking screw in intramedullary nailing are rare. No case of delayed pseudoaneurysm caused by a distal interlocking screw has yet been reported in Korea. We present two cases of delayed pseudoaneurysm caused by a distal interlocking screw several months after intramedullary nailing.

Keywords: femur shaft fracture, pseudoaneurysm, interlocking screw

Figures and Tables

Figure 1

A 17-year-old male had a traffic accident. (A) Preoperative radiograph showing the shaft of the femur fracture. (B) Postoperative radiograph of the femur after intramedullary nailing.

Figure 2

Ultrasonography of the left distal thigh showed an anechoic fluid collection like hematoma measuring 3.3×2.0×2.9 cm under the fasica of the vastus intermedius muscle (A) and turbulent blood flow in the hematoma (B).

Figure 3

Fat suppressed coronal T1 (A) and axial T2 (B) magnetic resonance contrast images of the left distal thigh showed a pseudoaneurysm with internal hematoma which has heterogenous intensity signal under the vastus intermedius muscle. The margin of the hematoma was surrounded by a low intensity signal band shaped sac, and the tip of the distal interlocking screw was detected inside the hematoma. A, anterior; P, posterior; M, medial; L, lateral.

Figure 4

Computed tomography angiography of the lower extremity showed a small vessel (arrow) around the distal screw area.

Figure 5

An 18-year-old male had a traffic accident. (A) Preoperative radiograph showing the shaft of the femur fracture. (B) The radiograph of the femur taken six weeks after the operation showing callus formation at the fracture site.

Figure 6

Ultrasonography of the left distal thigh showed a hematoma measuring 4.3×8.0×1.3 cm (A) with turbulent blood flow (B).

Figure 7

(A) Fat suppressed coronal T1 magnetic resonance (MR) contrast image of the left distal thigh showing a pseudoaneurysm with an internal hematoma. (B) Blood fluid level was shown adjacent to the distal interlocking screw tip in a hematoma on a fat suppressed axial T2 MR image. A, anterior; P, posterior; M, medial; L, lateral.

Figure 8

Follow-up ultrasonography of the left distal thigh showed resolution of the hematoma.

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