[Vascular injuries complicating osteosynthesis in proximal femur fractures]

While there are quite a number of reports on vascular injuries complicating hip arthropasty by acetabular component screw fixation, retractor tip pressure or extruding bone cement, the incidence of deep femoral vessel injuries in operative fixation of proximal femoral fractures is comparatively seldom described. We report on two patients with per- and subtrochanteric femoral fractures who sustained injuries of deep femoral artery branches during the implantation of a dynamic hip screw (DHS) and a dynamic condylar screw (DCS), which resulted in a massive thigh hematoma and a fist-size pseudoaneurysm respectively and necessitated surgical intervention in either case. We blame these vascular injuries on the pressure of Hohmann retractors exposing the femoral bone or on the drilling of boreholes for plate attachment. After discussing various operative procedures, we conclude that intramedullar implants are safer than plates with regard to potential vascular complications.