Avulsion of iliac vessels during internal fixation of intracapsular fracture of neck of femur—A case report

A 72-year-old female presented to A&E with a displaced intracapsular fracture of the left neck of femur (AO 31 B3). She had no significant past medical history and was non-smoker. She underwent routine pre-operative workup and was taken to theatres 2 h after injury for fixation. Under general anaesthesia the fracture was reduced on a traction table using image intensifier control. Via a mini-incision lateral approach three guidewires were inserted into the femoral head to a good position on antero-posterior (AP) and lateral plane fluoroscopy (Figs. 1 and 2). Each guidewire was drilled in turn and an appropriate length partially threaded cannulated screw inserted but as the third wire was being drilled it came loose andwas therefore extracted, re-inserted and re-screenedwith only an AP view. During re-insertion of this third cannulated screw, it was noticed that the screwwas advancing too far (Fig. 3). A further lateral plane image confirmed the placement of the screw anteriorly to the hip. It was not possible to retrieve the screw using standard instruments. An unsuccessful attemptwasmade by the Orthopaedic surgeon to reach the screw via an anterior abdominal approach, so the screw was left in situ and the wounds closed. Intraoperative anaesthetic monitoring showed no significant abnormalities. In recovery, the patient became hypothermic and tachycardic with a systolic pressure drop of 30 mmHg. Her left leg was cool with reduced pulses.