Profunda femoris vein laceration caused by a displaced lesser trochanter fragment: a case report of intraoperative vascular risk in intertrochanteric fracture.

Background: Vascular injury is a rarely reported complication of intertrochanteric fractures, with most literature focusing on arterial involvement. This case report describes an even rarer occurrence: a profunda femoris vein laceration caused by a displaced lesser trochanteric fragment, highlighting a potentially underrecognized intraoperative risk. Case presentation: We describe an 83-year-old male with an intertrochanteric fracture (AO/OTA 31-A2.2) in whom a displaced lesser trochanteric fragment was found in direct contact with the profunda femoris vein on preoperative CT. Despite negative Doppler ultrasound, surgical exploration revealed a 3 mm venous laceration, which was repaired. The fragment was resected before fracture fixation with an intramedullary nail. Postoperatively, the patient developed deep vein thrombosis, managed with an inferior vena cava filter and anticoagulation. Conclusions: This case illustrates that a displaced lesser trochanteric fragment in proximity to major vessels may carry a risk of intraoperative venous injury, even in the absence of preoperative signs. It highlights the importance of preoperative imaging review for anatomical risk assessment. While this single case cannot establish management protocols, it contributes to the awareness of venous injury as a potential complication in similar fracture patterns.