Abstract
Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.
Highlights
Case reportsOver the last three decades closed intramedullary nailing has become the gold standard technique for the treatment of femoral shaft fractures
The damage to circumflex vessels in case 1 and to endosteal blood supply and bone stock itself in case 2 resulted in late femoral neck fracture (FNF)
Apart from this suggestion, in case 1 the weakened, ischemic bone failed during physiologic stresses at bed rest after first fixation with ZESPOL, so we consider the possibility of a similar cause for FNF
Summary
Case reportsOver the last three decades closed intramedullary nailing has become the gold standard technique for the treatment of femoral shaft fractures. Since 2005 we have followed two cases with unusual complications attributed, in our opinion, to technical errors during the end stage of the procedure—end cup placement. In both cases Synthes universal femoral nails were used. Postoperative X-rays did not reveal signs of FNF, but on first follow-up after two weeks both patients were symptomatic, and anteroposterior (ap) radiograms revealed misplaced end cups and FNF.
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