Medial Displacement of the Proximal Femur is a Major Risk for Vascular Injury during Cerclage Wiring: A Case Report

Introduction: Vascular injury during cerclage wiring of the proximal femur is a rare but potentially 3 devastating complication. Interest in this technique has increased in the context of increasing numbers 4 of periprosthetic fractures. Based on our case this article discusses the technique and provides 5 recommendations for risk reduction in proximal femoral cerclage application. Case Presentation: We report a case of a 75-year-old female who sustained vascular strangulation 7 of the superficial and deep femoral artery and the femoral nerve from cerclage wiring of an extended 8 trochanteric and femoral osteotomy for stem removal during a hip arthroplasty revision procedure. 9 Medialized position of the proximal femur during cerclage application led to accidental strangulation of both arteries and the femoral nerve. Conclusion: Both patient-related and technical factors determine the risk of vascular injury. Special attention must be paid to the position of the femur in relation to the medial structures of the thigh; any kind of medialization increases the risk of vascular and neural injury.