Life-Threatening Proximal Femoral Fracture—Dislocation of the Lesser Trochanter Fragment at the Femoral Vascular Axis

Proximal femoral fractures are the most common fractures in Germany. Concomitant vascular injuries are extremely rare but potentially life-threatening. The current surgical standard for pertrochanteric femoral fractures is minimally invasive nail osteosynthesis, whereby the lesser trochanter fragment is usually not reduced or fixed. However, in individual cases, the muscle traction of the iliopsoas muscle can result in dislocation of the lesser trochanter fragment (green arrow) in the direction of the arterial axis, meaning that there is a risk of injury to the superficial femoral artery (white arrow) and the deep femoral artery artery (orange arrow), as in this case. Moreover, aneurysms in the further course have been described. Therefore, in the case of conspicuous dislocation of the lesser trochanter fragment, cross-sectional computed tomography to visualize the position of the fragment and, where necessary, resection of the fragment can be beneficial. In addition, one should select, as early on as at the primary treatment stage, surgical draping that enables rapid access to the groin region in the event of a vascular injury occurring during osteosynthesis due to manipulation of the fragment.

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Dr. med. Peter Melcher, Prof. Dr. med. Christian Kleber​, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, [e-mail]

PD Dr. med. Daniela Branzan, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig

Conflict of interest statement: CK is a member of the Johnson & Johnson trauma advisory board. A femoral nail fabricated by Johnson & Johnson was used in the case discussed here. The remaining authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Melcher P, Branzan D, Kleber C: Life-threatening proximal femoral fracture—dislocation of the lesser trochanter fragment at the femoral vascular axis. Dtsch Arztebl Int 2024; 121: 489. DOI: 10.3238/arztebl.m2023.0199