title: Fatal retroperitoneal hemorrhage caused by perforation of a guidewire pin for proximal femur fixation.
abstract: A 77-year-old woman with a slightly displaced intertrochanteric two-fragment fracture of the left hip was treated by internal fixation using a screw-nail device (gamma nail). After the operation she became hemodynamically unstable, and ultrasound revealed a large retroperitoneal fluid accumulation in the left lower abdomen. A contrast computed tomogram revealed active hemorrhage next to the quadrilateral surface of the left acetabulum. Selective angiography and embolization were immediately initiated and stopped the bleeding. However, despite the successful treatment of the retroperitoneal hemorrhage, the patient developed an oligosymptomatic myocardial infarction associated with clinical evidence of a cerebrovascular insult and pulmonary decompensation and died 2 weeks after her accident. The hemorrhage in this patient was most likely caused by surgical damage to the obturator artery during placement of the guidewire pin (with threaded tip) to position the screw of the implant.
authors: Department of Orthopedic Surgery, University of Berne, Inselspital, Switzerland. michael.leunig@insel.ch
authors: Michael
authors: M
authors: Leunig
authors: Michael
authors: M
authors: Meyer
authors: Martin
authors: M
authors: Beck
authors: Jürgen
authors: J
authors: Triller
authors: Alexander
authors: A
authors: Stupnicki
authors: Heinz
authors: H
authors: Zimmermann
mesh_terms: D000368:Aged; D000792:Angiography; D001858:Bone Nails / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006620:Hip Fractures / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010529:Peritoneal Cavity; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed