ArticleJournal of orthopaedic case reports2026
Superior Gluteal Artery Injury After Cephalomedullary Nailing of a Hip Fracture in a Patient on Anticoagulation: A Case Report and Literature Review.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Superior gluteal artery (SGA) injury following cephalomedullary nailing (CMN) is exceedingly rare. To our knowledge, this is the first reported case of acute SGA hemorrhage in a patient on therapeutic direct oral anticoagulant therapy, representing a clinically distinct presentation from previously described delayed pseudoaneurysm formation. Case Report: A 75-year-old anticoagulated female (apixaban, Factor V Leiden) sustained an intertrochanteric femur fracture treated with CMN. Three hours postoperatively, she developed hypotension, tachycardia, and a hemoglobin drop to 6.9 g/dL despite a dry wound. Gluteal swelling prompted computed tomography (CT) angiography, which identified active extravasation from an SGA branch. Selective coil embolization achieved hemostasis, and the patient was discharged on post-operative day 11. Conclusion: SGA injury is a rare but life-threatening complication of CMN. Unexplained hemodynamic instability with gluteal swelling should prompt urgent CT angiography and interventional radiology consultation. Anticoagulation should not delay timely hip fracture fixation.
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