Through-the-nail technique

Abstract

Ipsilateral fractures of the neck of the femur and the femoral shaft are uncommon injuries and they present considerable challenge as the concurrent survival of the femoral head and union of the femoral shaft fracture is of paramount importance. We present a young male patient who sustained a Garden IV fracture of the neck of his right femur following a road traffic accident, with the fracture being adjacent to an ipsilateral intramedullary nail inserted 10 years previously for a midshaft femoral fracture; the nail was broken, with its proximal fragment lying behind the greater trochanter. The patient was operated on within 6 hours from the injury. An attempt was made to remove the nail but this was abandoned as warring iatrogenic bone loss was encountered, due to the proximity of the fracture to the nail entry point. Instead, three cancellous lag-screws were inserted to fix the fracture in a triangular fashion. Two screws placed posteriorly behind the nail, and one anterior screw through the nail.