Intertrochanteric Femur Fracture in Severe Peripheral Vascular Disease Complicated by Acute Limb Ischemia and Amputation: A Case Report.

Introduction: Intertrochanteric (IT) femur fractures are among the most commonly encountered injuries in orthopedic practice and are typically managed successfully with internal fixation using cephalomedullary devices. Vascular complications following such procedures are rare and are most often limited to localized arterial injury or pseudoaneurysm formation. Progression to acute limb ischemia with subsequent limb loss is exceptionally uncommon, particularly in the setting of routine fracture fixation. The presence of severe peripheral vascular disease (PVD) may significantly alter this otherwise predictable clinical course. Case Report: We report the case of a 50-year-old male with advanced PVD who sustained a right IT femur fracture following a slip and fall at home. After thorough medical optimization and multidisciplinary evaluation, the patient underwent closed reduction and internal fixation with a proximal femoral nail. Despite an initially uneventful intraoperative course, the patient developed acute-on-chronic limb ischemia in the post-operative period, characterized by progressive loss of distal perfusion and tissue viability. Imaging confirmed diffuse multilevel arterial disease with poor distal runoff. Despite prompt anticoagulation, fasciotomy, and vascular consultation, limb salvage was not possible, and the patient ultimately required staged below-knee followed by definitive above-knee amputation. Conclusion: This case highlights a rare but catastrophic complication following IT fracture fixation in a patient with severe PVD. It underscores the critical importance of meticulous pre-operative vascular assessment, cautious use of traction during fracture reduction, early multidisciplinary involvement, and realistic perioperative counseling regarding the potential risk of acute limb ischemia and limb loss in high-risk patients.