Vascular Injury with Insertion of Anteroposterior Interlocking Screw of Retrograde Femoral Nail - Case Report

Introduction: Retrograde femoral nailing is a frequently performed surgical procedure used to stabilize a supracondylar femur fracture. We are reporting a unique case where the insertion of the anteroposterior interlocking screw of a retrograde nail caused vascular damage. Within the elderly patient population, we anticipate the presence of significant collateral blood vessels, which increases the potential for vascular damage during the insertion of a proximal screw. In this instance, there was bleeding caused by a vascular injury after the insertion of proximal interlocking screws, which necessitated further examination and vascular embolization on the following day. The complexity above necessitates that the author makes adjustments to surgical techniques when inserting proximal screws of a retrograde nail in similar cases.

Case report: An 82-year-old female patient presented with a right periprosthetic supracondylar femur fracture. The fracture was managed by retrograde nail femur. Vascular injury during proximal anteroposterior screw insertion results in post-operative bleeding and marked hemoglobin drop. The bleeding is managed by computed tomography emergent vascular embolization.

Conclusion: Vascular injury, due to the insertion of a proximal screw, is a rare but potentially dangerous complication that needs a high degree of suspicion to pick up and manage this rare serious complication promptly.