Delayed presentation of lateral femoral circumflex artery injury post cannulated hip screw surgery--a case report.

An elderly patient underwent cannulated hip screw surgery for a subcapital neck of femur fracture. Nine days post surgery, she was noted to have collapsed with a falling haemoglobin level. Computed tomography revealed a large haematoma to the thigh. Further angiography showed active bleeding from one of the branches of the lateral femoral circumflex artery (LFCA), which we postulate was caused by the sharp tip of a version guidewire used during fracture fixation surgery. Iatrogenic injury during hip fracture fixation is a rare event, particularly to the circumflex branches of the profunda femoris artery (PFA), and may occur from hard wire use intra-operatively or from the fracture itself. The LFCA branches laterally from the PFA, runs anterior to the femoral neck, where we suspect it was injured in our case. Whilst a version wire is a useful radiological guide intra-operatively, manually clearing a passage for its insertion into the femoral head/neck junction and using the blunt end is recommended. A combination of acute swelling in the operated region and falling haemoglobin post surgery should alert the clinician to possible vascular injury. Compared to duplex ultrasonography, CT angiography remains the gold standard in its specificity and sensitivity for diagnosing arterial injuries. With early recognition and prompt radiological intervention, this rare complication of fracture fixation surgery can be treated without the need for further surgery.