This paper reports a pseudoaneurysm of the anterior tibial artery after reduction with pointed bone reduction forceps on a spiral fracture of the distal tibia. Most reported injuries occurred at the proximal part of anterior tibial artery during drilling of the proximal tibia. To the best of the authors' knowledge, injury of the distal part of anterior tibial artery has never been reported. This paper describes a 54-year-old woman with a pseudoaneurysm of the anterior tibial artery clinically detected 11 weeks after the index surgery. This report highlights the need for surgeons to be aware of and careful about this complication during and after surgical intervention.
Aneurysm, False ; Female ; Humans ; Middle Aged ; Surgeons ; Surgical Instruments ; Tibia ; Tibial Arteries

PURPOSE: Proximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients. MATERIALS AND METHODS: From January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study. RESULTS: All patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems. CONCLUSION: Eighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.
Aged ; Femoral Fractures ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Humans ; Internal Fixators ; Neck ; Retrospective Studies