Clinical Diagnosis And Treatment With Pseudoaneurysm Of Profunda Femoris Artery After Fixation For Femoral Fracture: A Report Of3Cases

Objective: To understand the pseudoaneurysm of profunda femorisartery after fixation for femoral fracture, summarize and discuss the clinicaldiagnosis and treatment of profunda femoris artery injury.Methods: We collected3patients who had profunda femoris artery injuryafter fixation surgery for intertrochanteric femoral fracture or femoral shaftfracture from2012to2013in our department. Retrospectively study theirclinical data include: location and classification of fracture, anamnesis,operation histories, clinical feature of pseudoaneurysm, location of profundafemoris artery injury, therapeutic regimen and patients’ prognosis.Results: There are3patients of profunda femoris artery injury whichwere treated in our department from2012to2013.2patients followingproximal femoral nail antirotation(PFNA) fixation for intertrochantericfemoral fracture (both were EvenⅠ) and1patient following minimallyinvasive percutaneous plate osteosynthesis(MIPPO) for distal femur fracture（GustiloⅡ). None of them had arteriosclerosis or other occlusive disease.Clinical feature occurred in the fixation operation(1case) or6-7days after theoperation(2cases).2of the pseudoaneurysms located at the terminal branch ofthe second perforating bifurcation of the profunda femoris artery and1locatedat the initial branch of the third perforating bifurcation. Except1patientoccurred in the fixation operation and was treated with vessel ligation, allpatients presented again with a painful and a tense swelling in the affectedthigh without any history of further trauma. The pedes pulse were palpable,and the capillary refill in the feet was rapid. The pain was not controlled byanalgesics and was alleviated following coil insertion of the profunda femoris artery.1patient was presented with fasciotomy to avoid osteofacialcompartment syndrome and we gave delayed primary closure7days after theopration. All patients had a favorable prognosis and none of them recurred in5month．Conclusion：Patient with pseudoaneurysm of the profunda femoris arteryfollowing femoral fracture are rare, most of them present following dynamichip screw fixation or short gamma nail fixation. In the presence of on-goingthigh pain, swelling and anemia in the post-operative period should alert thesurgeon to a likely vascular injury. Angiography is the “gold standards” fordiagnosis. Early diagnosis and therapeutic intervention can result in a positiveoutcome.