Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
A 70-year-old man (height 160 cm and weight 63 kg) sustained a proximal femoral shaft fracture (AO/OTA classification 32A1) in a traffic accident (). No comminution was observed around the fracture surfaces. After reaming up to 12 mm, an 11 mm diameter, and 320 mm long nail was introduced manually. After the nail passed the proximal metaphysis, it was derotated gradually with successive mallet blows until it reached its intended location. When the proximal metaphysis was checked prior to proximal locking screw fixation, a newly developed proximal femoral fracture was observed under an image intensifier. This fracture started from the previous proximal fracture surface in the lateral aspect and propagated almost to the lesser trochanter, resulting in a proximal femoral shaft fracture with subtrochanteric extension ().