False aneurysm caused by failed fracture fixation

Patient JL was an 83-year-old man who suffered an unstable intertrochanteric fracture of the femoral neck reduced and fixed with a sliding hip screw. Over the following 2 months he developed pain in the right groin which prevented him from walking. A pulsatile mass in the right groin was found. A pelvic radiograph demonstrated that the plate had pulled away from the femur thus failing to maintain reduction of the fractured hip (Figure 1). Ultrasound and then arteriography confirmed the presence of a profunda femoris pseudoaneurysm. The profunda femoris artery was patent and compressed from below by a large pseudoaneurysm (3.2 cm by 4.0 cm in cross section and 5.0 cm in length) (Figures 2, 3 and 4)). The proximal end was 5.0 cm from the origin of the profunda femoris artery. Radiological intervention was considered to be the most appropriate option because of the technical difficulty and high risk of open surgery. Left common femoral artery puncture with use of an up and over technique to reach the right common femoral artery and right profunda femoris artery was used. The neck of the pseudoaneurysm was isolated and embolization achieved by placing coils distal and proximal to the neck using seven coils in total. Post-embolization arteriography showed no filling of the pseudoaneurysm and good collateral supply of the limb. The lump in the groin became non-expansile and gradually reduced in size. The patient made a good recovery from the procedure and revision of the sliding hip screw was now possible.