Application of a self-developed femoral artery compression hemostasis device in proximal femoral nail anti-rotation surgery for intertrochanteric fractures: a case report

Background Intertrochanteric fractures of the femur are a prevalent type of hip fracture among the elderly. While surgical treatment is the preferred approach for managing these fractures, conventional tourniquets cannot be applied in hip surgery due to anatomical constraints. As a result, effectively controlling intraoperative and perioperative blood loss has long posed a significant clinical challenge. Case presentation A 70-year-old male patient with a comminuted fracture in the left intertrochanteric region of the femur underwent closed reduction and internal fixation using a proximal femoral nail anti-rotation (PFNA). During the procedure, a proprietary compression-type femoral artery hemostasis device was used to effectively control regional blood flow. The femoral artery pulsation was palpated inferior to the inguinal ligament and superior to the pubic ramus. A compression device was then applied to achieve precise compression of the femoral artery. Effective compression was indicated by the absence of the dorsalis pedis artery pulse, which helped maintain collateral circulation. The procedure lasted 45 min, with an estimated intraoperative visible blood loss of 50 mL. Quantitative analysis using the Gross formula, based on the patient's hematocrit decline from 0.394 preoperatively to 0.358 on postoperative day 2, revealed a calculated total perioperative blood loss of 433 mL, with hidden blood loss accounting for 383 mL. There were no postoperative complications, including limb ischemia, nerve injury, or deep vein thrombosis. The patient was discharged in good condition 6 days after surgery. A follow-up examination at 6 weeks postoperatively revealed satisfactory callus formation at the fracture site and stable internal fixation. Conclusion In this single case, application of the self-developed femoral artery compression hemostatic device was associated with reduced intraoperative blood loss and a favorable safety profile during PFNA fixation of an intertrochanteric fracture. The device may offer a novel, non-invasive hemostatic strategy for selected hip fracture surgeries; however, further studies are required to confirm its efficacy and safety.