Abstract
We describe a rare case with breakage of gamma nail accompanied by nonunion of the original fracture and a subsequent new fracture in the ipsilateral femur. A 73-year-old woman suffered a subtrochanteric fracture of the femur, and the fracture was fixed with gamma nail at a previous hospital. However, fracture reduction was not adequately achieved and a large gap remained between the fracture fragments. The fracture demonstrated atrophic nonunion 10 months after surgery, and autologous bone grafting was performed at the same hospital. Two months after the second surgery, a breakage of the nail at the distal screw hole was observed. Twenty-six months after the second surgery, the patient fell and a fracture occurred at the level of the nail breakage. The atrophic nonunion site and fresh fracture site were very close thus demonstrating a segmental fracture. We exchanged the original gamma nail with a long gamma nail and performed autologous bone grafting at the nonunion site. Both the fresh fracture site and the nonunion site obtained bony union. This tragic chain of events was caused by inappropriate initial treatment and replacing the nail to a longer nail and autologous bone grafting were effective as salvage surgery.
Highlights
Gamma nail is a commonly used implant for the treatment of proximal femur fractures [1] and breakage of the nail is a relatively rare complication
We present a rare patient with breakage of gamma nail accompanied by nonunion of the original fracture and a subsequent new fracture in the ipsilateral femur
The fracture was fixed with a second-generation gamma nail (Gamma APJ (Asia Pacific Japan) nail, Stryker, Japan) at a previous hospital; fracture reduction was not adequately achieved and a large gap remained between the fracture fragments (Figure 1(b))
Summary
Gamma nail is a commonly used implant for the treatment of proximal femur fractures [1] and breakage of the nail is a relatively rare complication. We present a rare patient with breakage of gamma nail accompanied by nonunion of the original fracture and a subsequent new fracture in the ipsilateral femur. We describe the case and discuss the causes and treatment
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