Pseudoaneurysm Formation in the Superior Gluteal Artery Following Short Femoral Nail Placement in an Intertrochanteric Femur Fracture: A Case Report

Introduction: Superior gluteal artery (SGA) injury is an uncommon, yet critical complication associated with trochanteric fracture surgery. While deep femoral artery branches are more frequently affected, SGA involvement is infrequent but potentially life threatening. Knowledge of anatomy plays a crucial role in reducing the likelihood of such complications. Factors contributing to deep femoral artery injury include direct trauma from fracture fragments, excessive drilling, or inadvertent arterial damage during instrumentation. To date, only a few cases have reported SGA injuries following trochanteric fracture surgery. In this study, we report a late presented SGA pseudoaneurysm after intramedullary nailing of intertrochanteric fracture.

Case report: A 72-year-old female with a right intertrochanteric fracture underwent surgery involving the placement of a short cephalomedullary nail. In the 3rd week postoperatively, the patient presented with a sizable hematoma near the proximal and posterior section of the incision. Subsequent investigations unveiled a pseudoaneurysm in the SGA as the source of the hematoma and declining hemoglobin levels. The pseudoaneurysm was successfully treated with embolization, and the patient recovered without complications.

Conclusion: Prompt recognition of post-operative hemoglobin decrease, regardless of clinical symptoms, is essential. Computed tomography angiography is valuable for early detection and intervention of SGA injuries. Surgeons must be careful when opening the incision and determining the entry point, as anterior incision and medialized guidewire may increase the risk of SGA injury. Awareness of this rare complication and its management is vital to prevent possible complications.