Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Femur
Abstract number: 22834
REPEAT STRESS FRACTURE OF RECONSTRUCTION NAIL MANAGED BY
REVISION STEM TOTAL HIP REPLACEMENT (THR)
Gautam TALAWADEKAR, Manju REDDY, Luc LOUETTE, Parthiban VINAYAKAM
Qeqm Hospital, Margate, Margate (UNITED KINGDOM)
Introduction: Subtrochanteric femur fractures have higher non-union rate than
intertrochanteric & shaft fractures. One of the known complications reported with
intramedullary fixation is implant failure, usually as a result of fracture non-union with
incidence from 0.3-5%. We report a 66yr old lady who presented with subtrochanteric
fracture with nail breakage 2 yrs after exchange nailing who then underwent revision
stem THR with good function. Case report 66yr old rheumatoid lady sustained left hip
injury. Radiographs revealed a left subtrochanteric fracture with hip arthritis. Patient
bore full weight after fracture stabilization using Recon nail. Although radiographs at
3 months revealed ununited fracture patient denied having hip pain & declined
surgical intervention. However, 2yrs later patient had acute onset left hip pain with
inability to weight-bear without history of trauma. She underwent exchange nailing for
the non-union. At follow up, fracture appeared united radiologically & clinically,
evidenced by lack of hip pain & ability to fully weight bear. After another 2 yrs, patient
presented with hip pain following a fall. Radiographs revealed broken nail. A revision
stem THR using a long-stem femoral prosthesis was done. Discussion Fatigue
fractures of recon-nails could be managed by repeat nailing, surface fixation or
hemiarthroplasty. Initial nail failure followed by failure of repeat nailing, then managed
by THR, makes our case unique. Surprisingly, patient remained asymptomatic for 2
yrs after the second nailing despite underlying nonunion, which was not evident on
radiographs. Coincidentally, a similar fracture on the other side that was managed
identically, healed after the first nailing.
520