Pseudoaneurysm of the profunda femoris artery following an inter-trochanteric fracture of the femur

Abstract

A 50-year-old gentleman was admitted under our services after a fall onto his right side. He sustained an inter-trochanteric fracture of his right femur with reverse obliquity pattern and a displaced fracture of the surgical neck of his right humerus. He had a history of alcohol abuse, but his past medical history was otherwise non-contributory. He underwent dynamic hip screw fixation of his right femur and Polarus nail insertion of his right humeral fracture. His post-operative stay was complicated by delerium tremens and a below knee DVT which required treatment with warfarin. Subsequent radiographs demonstrated stable medial displacement of the femoral shaft. Following stabilisation of his medical condition, he was discharged home on crutch walking. He was re-admitted seven months later with severe pain in his right groin radiating to the anterior aspect of his right thigh and weakness of his right leg. On examination, he was found to have a large nonexpansile pulsatile mass in his right groin. Arteriography was performed which confirmed the presence of a large pseudoaneurysm arising from the profunda femoris artery. He was also noted to have an ilio-femoral thrombosis and a Greenfield filter was therefore inserted. Attempted embolisation of his pseudoaneurysm failed. He then underwent surgical repair of his pseudoaneurysm. Post-operatively he was unable to straight leg raise and EMG studies demonstrated a severe femoral neuropathy. He was discharged form hospital on crutch walking (Figs. 1—3).