Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2015; 6(9): 738-743
Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.738
Subtrochanteric fractures after retrograde femoral nailing
Varatharaj Mounasamy, Sathya Mallu, Vishesh Khanna, Senthil Sambandam
Varatharaj Mounasamy, Sathya Mallu, Department of Orthopedics, Virginia Common wealth University Health System, Richmond, VA 23298, United States
Vishesh Khanna, Senthil Sambandam, Department of Orthopedics, KG Hospital, Coimbatore 641018, Tamil Nadu, India
Author contributions: Mounasamy V, Mallu S, Khanna V and Sambandam S contributed equally to this work; Mounasamy V and Mallu S designed the research; Mounasamy V and Mallu S performed the research; Mounasamy V and Mallu S analysed the data; Mounasamy V, Khanna V and Sambandam S wrote the paper.
Conflict-of-interest statement: Drs. Varatharaj Mounasamy, Sathya Mallu, Vishesh Khanna and Senthil Nathan Sambandam, have not received fees for serving as a speaker, nor have they received research funding from any organization. There are no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vishesh Khanna, DNB Orthopaedics, Department of Orthopedics, KG Hospital, Arts College Road, Coimbatore 641018, Tamil Nadu, India. visheshkhanna85@gmail.com
Telephone: +91-981-1844647 Fax: +91-422-2211212
Received: March 23, 2015
Peer-review started: March 26, 2015
First decision: June 3, 2015
Revised: June 21, 2015
Accepted: July 21, 2015
Article in press: July 23, 2015
Published online: October 18, 2015
Processing time: 210 Days and 16.3 Hours
Abstract

Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.

Keywords: Peri-implant fracture; Retrograde femoral nail; Antegrade femoral nailing; Interlocking screw; Subtrochanteric fractures

Core tip: The occurrence of peri-implant subtrochanteric fractures in patients operated previously by retrograde nailing for femoral diaphyseal fractures has been rarely reported. This case report provides the description of two such cases with subtrochanteric peri-implant fractures. These challenges are best met, according to our experience, by implant removal, open reduction and interlocking antegrade nailing.