A 79-year-old woman with a history of osteoporosis treated with alendronate presented to the orthopaedic clinic with persistent left hip pain. X-ray and bone scan revealed an atypical femoral fracture associated with bisphosphonate use. The fracture was repaired with antegrade femoral intramedullary fixation. Her postoperative course was complicated by acute blood loss anaemia requiring several packed red blood cell transfusions and progressive thigh ecchymosis. CT angiography demonstrated extravasation of contrast from the superior gluteal artery (SGA). Subsequent angiography revealed an SGA pseudoaneurysm above the intramedullary nail, which was coil embolised. Iatrogenic SGA injury secondary to femoral intramedullary fixation is a rare complication, with only one previous case reported in the literature. Therefore, successful identification of the injury required attention to patient reported symptoms, neurovascular examinations and laboratory values to determine the cause of the patient’s postoperative anaemia. The patient made a full recovery and did not have any long-term adverse effects following the embolisation.
- calcium and bone
- orthopaedic and trauma surgery
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Contributors GG conceived of the presented idea. Data acquisition was performed by NA and LG. NA, ROC and LG prepared the manuscript draft with important intellectual input from GG. All authors participated in critical revision of the manuscript draft. All authors have approved the final manuscript to be published and the entirety of the submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests GG reports grants from Depuy Synthes, grants from AOTrauma North America, grants, personal fees and non-financial support from Orthosensor, Inc., personal fees from Arthroplasty Today, grants from Cerus, grants from KCI. He is on the editorial board for Journal of Arthroplasty, is a committee member for the American Association of Hip and Knee Surgery and is a board member for the Virginia Orthopaedic Society.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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