Abstract
Intramedullary (IM) nail fixation is widely used for the treatment of atypical fractures of the femoral shaft. The configuration and location of proximal interlocking screws are unique to each nailing system and maybe transverse or oblique in direction. The authors experienced two cases of incomplete secondary fractures at the subtrochanteric region after IM nail fixation for atypical femoral shaft fractures. The proximal screw fixation of the two cases was different from one another. One was fixed with a spiral blade plus transverse screw and the other was fixed using an oblique direction screw from the greater trochanter to the femoral neck base. Based on our experience, we recommend only using a proximal locking screw toward the head when using an IM nail for the treatment of atypical femoral diaphyseal fractures.An 82-year-old female patient who had been fixed with an IM nail for the treatment of atypical femoral shaft fracture 13 months ago visited the outpatient clinic with pain in the right hip joint for one month. Local hot uptake was observed at the proximal interlocking screw insertion site around the subtrochanteric region on bone scan. A simple removal of the proximal locking screw was enough to treat the incomplete fracture.A 79-year-old woman visited the emergency room for pain in the right hip joint. On the radiograph, the right femur was found to be fixed with an IM nail, and an incomplete fracture line around the lower border of the lesser trochanter was observed. This patient was treated by replacing the IM nail with a reconstruction nail.When using an IM nail for the treatment of atypical femoral shaft fractures, it is appropriate to insert only the screw toward the femoral head for proximal fixation to prevent secondary subtrochanteric fracture.
Highlights
The diagnosis and treatment of atypical femoral fractures (AFFs) have been scarcely reported in the literature, and they are believed to be associated with long-term bisphosphonate drug use [13]
We have come across two reports of secondary fractures in the subtrochanteric region after IM nail fixation of atypical femoral shaft fractures in the literature [8,9]
The authors experienced two cases of incomplete secondary subtrochanteric fractures after IM nail fixation for diaphyseal AFF, and we discuss them in this report along with a review of the literature
Summary
The diagnosis and treatment of atypical femoral fractures (AFFs) have been scarcely reported in the literature, and they are believed to be associated with long-term bisphosphonate drug use [13]. Thirteen-month follow-up anteroposterior (A) and lateral (B) radiographs show complete healing of the previous incomplete fracture at the subtrochanteric region, incomplete fracture line, and anterior cortical thickening at the lower border of the lesser trochanter. The right femur was fixed with an IM nail, and radiolucent lines and cortical thickening on anteroposterior and lateral views were found around the lower border of the lesser trochanter (Figure 6). It was diagnosed as an incomplete subtrochanteric femoral fracture. Six-month follow-up anteroposterior (A) and lateral (B) radiographs show complete healing of the subtrochanteric fracture
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