Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
A 27-year-old woman (height 157 cm and weight 48 kg), with chronic renal failure and a previous complete lumbar spinal cord injury, sustained a femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] classification 32B1) (). After reaming up to 13 mm, a 12 mm diameter, and 340 mm long nail was introduced manually. During the passage of the proximal metaphysis, resistance was felt. We then checked for evidence of fracture using an image intensifier, but no fracture was detected. Insertion of the IM nail was progressed with the image intensifier, focused around the fracture site. After inserting the nail, and while attempting to fix the proximal locking screw, a 7-8 cm long longitudinal fracture was observed along the lateral cortex from the vastus ridge to below the lesser trochanter. Due to severe osteoporosis (T score, -4.3), we believed that poor bone quality had caused the iatrogenic subtrochanteric fracture in this patient ().