Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review
Abstract
1. Introduction and Clinical Significance
2. Case Presentation

3. Discussion
3.1. Clinical and Paraclinical Diagnosis
3.2. Treatment and Prognosis
3.3. Risk Factors
3.4. Preventive Considerations
- Postoperative surveillance—A sudden drop in hemoglobin levels, expanding hematoma, or persistent thigh pain should prompt immediate imaging evaluation (Doppler ultrasound or CT angiography). Clinicians should also be aware that beta-blocker therapy may mask tachycardia, potentially delaying recognition of internal bleeding [2,20].
3.5. Limitation
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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| First Author/Year/Reference | Article Type/Total Nr. of Cases/Incidence | Fracture Type (n) | Fracture Treatment (n) | Type of Lesion (n) | Location (n) | Mechanism of Injury (n) | Diagnosis (n) | Vascular Treatment (n) | Outcome (n) |
|---|---|---|---|---|---|---|---|---|---|
| Barquet et al., 2015 [1] | Systematic review/ 182/0.49% | Trochanteric (n = 132) Subtrochanteric (n = 12) Trochantero-diaphyseal (n = 5) Femoral neck (n = 28) Proximal femur- unspecified (n = 5) | Non-surgical (n = 3); Screws (n = 6); Pins (n = 2); Nail (n = 3); Nail plate (n = 19); Sliding nail plate (n = 1) SHS (n = 71); SHS + stabilizing plate (n = 1); SHS + antirotation screw (n = 1) Valgus osteotomy + SHS (n = 1) DLBP Gannet (n = 1); PCCP (n = 1) Ender nails (n = 5) Cephalomedullary nail -short (n = 45) Cephalomedullary nail -long (n = 9) Cephalomedullary nail long + cerclage (n = 1); Intramedullary nail- unspecified (n = 2); Gliding nail/revision (n = 1); Dynamic condylar screw/revision (n = 1); 958 angled blade plate (n = 2); Gamma nail-short (n = 2); PFN/PFNA (n ≥ 3) ORIF/undetermined (n = 3) | Pseudoaneurysm (n = 130); Laceration (n = 42); Thrombosis (n = 31); Arteriovenous fistula (n = 5); Intimal flap tear (n = 2); Compression (n = 1); Hematoma (n = 1) | Deep femoral artery (n = 129); Superficial femoral artery (n = 18); External iliac artery (n = 8); Internal iliac artery (n = 1); Common femoral artery (n = 5); Medial circumflex artery (n = 1); Lateral circumflex artery(n = 4); Obturator artery (n = 3); Popliteal artery (n = 4); Superior gluteal artery (n = 2); Common iliac vein (n = 1); External iliac vein (n = 3); Common femoral vein (n = 2); Unspecified vessel (n = 1) | Lesser trochanter fragment (n = 74); Overshot drill bit (n = 43); Protruding screw (n = 27); Traction/orthopedic table (n = 12); Retractor (n = 7) Other bone fragment (n = 9); Guide wire/reamer (n = 2); Implant migration (n = 5); Ender nails (n = 1); External fixator screw (n = 1); Cerclage wire(n = 1) | Angiography (n = 92); CT/CTA (n = 41); Ultrasound (n = 31) MRI (n = 2); Venography (n = 4); X-rays (n = 2) Intraoperative finding (n = 10) | Artery repair (n = 54); Artery ligation (n = 38); End-to-end anastomosis (n = 6); Vein repair/ligation (n = 7); Bypass graft (n = 3); Endovascular embolization (n = 38); Stent (n = 12); Thrombectomy/angioplasty (n = 4) Bone fragment removal (n = 5); Conservative (n = 9); Amputation (n = 2); Death before treatment (n = 4) | Uneventful recovery (n = 140); Death-vascular-related (n = 5); Death -unrelated (n = 3); Amputation (n = 2); Infection- controlled (n = 2); Infection-persistent (n = 1); Gangrene/toe resection (n = 2); Occlusion (n = 1); Vein thrombosis (n = 1); Neurological impairment (n = 2); Functional limitation (n = 1); Girdlestone procedure (n = 1); Other sequelae (n = 21) |
| Agustín et al., 2022 [7] | Systematic review/ 40/20 unique cases | Intertrochanteric (n = 15); Subtrochanteric (n = 3); Femoral neck (n = 1); Pathological intertrochanteric (n = 1) | DHS/SHS (n = 9); PFN/PFNA (n = 7); Gamma nail (n = 2); Arthroplasty (n = 1) Other (n = 1) | Pseudoaneurysm (n = 17); Laceration (n = 2); Thrombosis (n = 1) | Deep femoral artery (n = 15); Superficial femoral artery (n = 2); External iliac artery (n = 1); Obturator artery (n = 1); Lateral circumflex femoral artery (n = 1) | Protruding screw (n = 7); Overshot drill bit (n = 5); Lesser trochanter fragment (n = 3); Implant migration (n = 2); Guide wire (n = 1); Other (n = 2) | Angiography (n = 7); CT/CTA (n = 5); Ultrasound-based (n = 6); MRI (n = 1); Intraoperative finding (n = 1) | Surgical repair/ligation/graft (n = 12); Endovascular (n = 6); Conservative (n = 1); Amputation (n = 1) | Uneventful recovery (n = 16); Death (n = 1); Chronic pain/sequelae (n = 1); Recurrence/reintervention (n = 1) Not specified (n = 1) |
| Segal et al., 2017 [2] | Retrospective cohort study/ 1469/0.2% (3 cases) | Intertrochanteric (n = 3) | Gamma nail (n = 2); DHS (n = 1) | Active bleeding/pseudoaneurysm (n = 3) | Deep femoral artery (n = 3) | Overdrill (n = 2) Lesser trochanter fragment (n = 1) | CTA (n = 3) | Conservative (n = 1); Coil embolization (n = 1) Thrombin injection (n = 1) | Uneventful recovery (n = 3) |
| Kim et al., 2020 [8] | Case report and literature review/1/- | Intertrochanteric (n = 1) | Gamma nail (n = 1) | Arteriovenous fistula (n = 1) | Common femoral artery, superficial femoral artery, deep femoral artery and femoral vein (n = 1) | Overdrill/implant manipulation (n = 1) | Doppler ultrasound initial (n = 1); CTA confirmation (n = 1) | Open surgical repair with vein graft (n = 1) | Uneventful recovery (n = 1) |
| Orapiriyakul et al., 2022 [4] | Case report and literature review/1/- | Intertrochanteric (n = 1) | PFN + cerclage wire (n = 1) | Pseudoaneurysm (n = 1) | Branch of deep femoral artery (n = 1) | Cerclage wire (n = 1) | Doppler ultrasound -initial (n = 1); CTA confirmation (n = 1) | Open surgical repair with direct suture (n = 1) | Uneventful recovery (n = 1) |
| Samaan et al., 2023 [6] | Case report/1/- | Intertrochanteric (n = 1) | DHS (n = 1) | Laceration/perforation with active bleeding (n = 1) | Deep femoral artery (n = 1) | Long self-tapping DHS screws (n = 1) | Doppler ultrasound- false negative (n = 1) Intraoperative finding (n = 1) | Arteriorrhaphy (direct suture) + screw removal (n = 1) | Uneventful recovery (n = 1) |
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Bot, R.; Tirla, A.; Cavalu, S.D. Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review. Reports 2025, 8, 191. https://doi.org/10.3390/reports8040191
Bot R, Tirla A, Cavalu SD. Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review. Reports. 2025; 8(4):191. https://doi.org/10.3390/reports8040191
Chicago/Turabian StyleBot, Robert, Adrian Tirla, and Simona Daniela Cavalu. 2025. "Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review" Reports 8, no. 4: 191. https://doi.org/10.3390/reports8040191
APA StyleBot, R., Tirla, A., & Cavalu, S. D. (2025). Vascular Complications Following Trans-Trochanteric Fracture: Case Report and Literature Review. Reports, 8(4), 191. https://doi.org/10.3390/reports8040191

