Iatrogenic injury to the profunda femoris artery during distal locking of an intertrochanteric fracture: A case report and literature review

Proximal femoral nail antirotation, a common surgical procedure for intertrochanteric fractures, is rarely associated with deep femoral artery injury during distal locking in clinical practice. This article reports a unique case in which excessive penetration of a distal locking drill bit through the medial cortex during proximal femoral nail antirotation internal fixation caused accidental injury to the mid-to-distal branch of the deep femoral artery, resulting in a pseudoaneurysm with active bleeding. The diagnosis was confirmed using digital subtraction angiography, after which emergency endovascular coil embolization was successfully performed to achieve hemostasis. The patient showed significant improvement and was discharged without recurrence during follow-up. This case highlights the need for a high index of suspicion for potential deep femoral artery injury in patients presenting with extensive skin bruising accompanied by a pulsatile mass, particularly in older individuals and those with osteoporosis. Additionally, implementing appropriate preventive measures during surgery to avoid deep femoral artery injury is crucial.