Four-Time Failed Subtrochanter Femur Fracture Fixation in Elderly: What's Next - A Case Report.

Abstract

Introduction: Subtrochanteric fractures are difficult fractures to manage, and a failed fixation in these fractures is a complex and challenging entities. Re-osteosynthesis and prosthesis replacement are two viable options. We present a case of four failed subtrochanter fracture fixations, managed with cementless long stem total hip replacement and augmented plate.

Case report: A 68-year-old lady presented with pain and difficulty in walking for 12 years with four failed surgeries. The initial diagnosis was a subtrochanteric fracture managed with a proximal femur nail. The construct failed and was revised with a proximal femur plate. After a few years, the plate was broken and revised with the proximal femur nail again. Subsequently, the nail also failed after 3 years for which re-osteosynthesis with proximal femur nail was performed. The fixation again failed after 3 years leading to the inability to bear weight on the limb and pain. Cementless long stem total hip replacement with augmented plate along with bone grafting was performed as a one-time solution to the complexities in the management of 4 time-failed subtrochanter femur fractures. At 1 year of follow-up, the patient was walking pain-free and independently without any aid.

Conclusion: Failed subtrochanter femur fracture fixation is a complex situation to manage. Re-osteosynthesis is the favored modality of treatment but prosthesis replacement is a feasible option in elderly patients. Total hip replacement provides a single solution to all the intricate problems in the management of failed subtrochanter femur fractures in the elderly.