Superior Gluteal Artery Injury After Cephalomedullary Nailing of a Hip Fracture in a Patient on Anticoagulation: A Case Report and Literature Review.

Abstract

Introduction: Superior gluteal artery (SGA) injury following cephalomedullary nailing (CMN) is exceedingly rare. To our knowledge, this is the first reported case of acute SGA hemorrhage in a patient on therapeutic direct oral anticoagulant therapy, representing a clinically distinct presentation from previously described delayed pseudoaneurysm formation.

Case report: A 75-year-old anticoagulated female (apixaban, Factor V Leiden) sustained an intertrochanteric femur fracture treated with CMN. Three hours postoperatively, she developed hypotension, tachycardia, and a hemoglobin drop to 6.9 g/dL despite a dry wound. Gluteal swelling prompted computed tomography (CT) angiography, which identified active extravasation from an SGA branch. Selective coil embolization achieved hemostasis, and the patient was discharged on post-operative day 11.

Conclusion: SGA injury is a rare but life-threatening complication of CMN. Unexplained hemodynamic instability with gluteal swelling should prompt urgent CT angiography and interventional radiology consultation. Anticoagulation should not delay timely hip fracture fixation.