Challenges in Subtrochanteric Femur Fracture Management: A Case Report of Inappropriate Implant Choice Leading to Fixation Failure and Update on Management Options

Subtrochanteric fractures of the femur remains one of the most challenging fractures encountered by orthopaedic surgeons. They account for 10 to 15% of all hip fractures. Subtrochanteric region of the femur is defined as the proximal femoral shaft located within 5 cm of the lesser trochanter. It is common in older patients after low energy trauma along with osteoporosis and in younger patients with high energy trauma. The management of subtrochanteric fractures is challenging because of the inherent instability of the fracture pattern. Fractures to this area can result in significant complications and poor clinical outcomes such as failure of fixation, shortening, malrotation and non-union if not managed properly and inappropriate choice of implant was used. We are presenting a case report of an elderly lady with history of alleged fall in bathroom at home and sustained closed left subtrochanteric femur fracture. She was initially planned for dynamic hip screw fixation however choice of implant was changed to interlocking femoral nail during preoperative census meeting. Patient underwent interlocking nail of left femur. Intraoperative reduction was satisfactory. However, on day 1 postoperative was noted that distal femur was externally rotated and proximal femoral fragment displaced in valgus direction. There was a failure of fixation and patient was counselled for operation in which patient’s family declined and opted for conservative management. The purpose of this presentation is to highlight the challenges, examine the various treatment modalities and implant options in treatment of subtrochanteric femur fracture for optimal postoperative outcome.