Profunda femoris vein laceration from lesser trochanter fragment in hip fracture

Overview

This case report details an 83-year-old male with an intertrochanteric fracture complicated by an intraoperative laceration of the profunda femoris vein caused by a displaced lesser trochanter fragment. Despite negative preoperative Doppler ultrasound, surgical exploration revealed and allowed repair of a 3 mm venous laceration, underscoring the risk of venous injury in such fracture patterns.

Background

Vascular injuries in intertrochanteric fractures are rare, occurring in approximately 0.2% of cases and predominantly involving arterial structures. Displaced lesser trochanter fragments have been reported to cause arterial pseudoaneurysms or lacerations, but venous injuries, particularly to the profunda femoris vein, are scarcely documented. Preoperative imaging may not always detect venous injury, posing diagnostic challenges. Awareness of this potential complication is important for surgical planning and patient safety.

Data Highlights

Patient: 83-year-old male with AO/OTA 31-A2.2 intertrochanteric fracture.
Preoperative hemoglobin: 128 g/L; Day 2: 118 g/L; Day 3: 115 g/L.
Preoperative imaging: CT showed displaced lesser trochanter fragment contacting profunda femoris vein; Doppler ultrasound negative for vascular injury.
Intraoperative finding: 3 mm laceration of profunda femoris vein.
Postoperative complication: Deep vein thrombosis managed with inferior vena cava filter and anticoagulation.

Key Findings

• A displaced lesser trochanter fragment can lie in direct contact with the profunda femoris vein, posing a risk of venous injury.
• Preoperative Doppler ultrasound may fail to detect venous lacerations despite high-risk anatomical relationships seen on CT.
• Intraoperative exploration is critical for identifying and repairing venous injuries in such cases.
• Resection of the offending bony fragment prior to fracture fixation can prevent catastrophic hemorrhage.
• Postoperative deep vein thrombosis is a potential complication following venous injury and repair, requiring vigilant management.

Clinical Implications

Clinicians should carefully review preoperative CT imaging for displaced lesser trochanter fragments in proximity to major vessels, even when Doppler ultrasound is negative. Proactive intraoperative vascular exploration and fragment resection may be warranted to prevent venous injury. Awareness of this rare complication can improve surgical planning and patient outcomes.

Conclusion

This case highlights the underrecognized risk of profunda femoris vein laceration from displaced lesser trochanter fragments in intertrochanteric fractures. Thorough preoperative imaging review and intraoperative vigilance are essential to identify and manage this potentially serious complication.

References

1. Case Report -- Laceration of the profunda femoris vein due to a displaced lesser trochanter fragment