Abstract
An 85-year-old male presented with a hip fracture following an accidental fall. His medical history included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus.
He underwent intramedullary nail insertion, supplemented with a plate and screws, for a subtrochanteric fracture. Post-operatively, he received four units of red blood cells for low haemoglobin. He was unable to mobilise due to persistent swelling and pain, and recurrent drops in haemoglobin levels despite multiple transfusions, with no evidence of visible bleeding from the wound or other sites. However, pelvic x-rays showed stable fixation of the hip.
The patient subsequently developed extensive deep vein thrombosis in the contralateral leg and was started on a therapeutic dose of low molecular weight heparin. Further acute drops in his haemoglobin prompted an ultrasound of his hip, which identified an intramuscular hematoma. A CT angiogram confirmed active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The imaging also revealed a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. The patient underwent coil embolisation under radiological guidance, successfully achieving complete haemostasis.
Following the procedure, pain and swelling improved, haemoglobin levels remained stable, and he tolerated full anticoagulation without further drops in haemoglobin. Additionally, his mobility improved, and he transferred to a rehabilitation unit before being discharged home.
CONCLUSION
Pseudoaneurysms following hip fracture surgery are rare. Persistent drops in haemoglobin, along with pain, swelling, and stable fixation of an intramedullary nail, should raise suspicion for a haematoma, warranting further investigation with a CT angiogram.