Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
A 63-year-old man (height 169 cm and weight 72 kg) with multiple trauma injuries presented with a middle femoral shaft fracture (AO/OTA classification 32B1) (). After reaming up to 14 mm, a 13 mm diameter, and 360 mm long nail was inserted. However, when the targeting device was slowly rotated following the passage of the proximal metaphysis after confirming the central direction of nail's tip during insertion, resistance was felt, and cortical breakage along the lateral cortex in the subtrochanteric area was observed under an image intensifier. The newly developed fracture was on the lateral side and had a distance from the original fracture site; therefore, we considered it as a missed, concealed ipsilateral proximal femoral fracture rather than an iatrogenic fracture comminution. Accordingly, we continued the nail insertion (with gradual rotation) until a cracking sound was heard. The result was a displaced complete subtrochanteric fracture ().