Use of Huckstep nail in the periimplant femoral shaft fracture

Abstract

87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

Keywords: Femur; Huckstep nail; periimplant fracture; stress riser.

Figure 1

Initial X-ray on the day of trauma shows supracondylar area fracture which is extended to the intraarticular area (a, b)

Figure 2

Postoperative anteroposterior (a) and lateral (b) radiographs of the left distal femur revealing a good reduction

Figure 3

X-rays of the thigh anteroposterior view (a) and lateral view (b) shows stress riser fracture between the distal tip of the previous nail and proximal tip of the LCP plate on the postoperative 8^th day

Figure 4

Immediate postoperative anteroposterior (a) and lateral (b) radiographs of the left femur showing newly inserted Huckstep nail without removal of the previous LCP

Figure 5

Final followup at 15 months postoperative anteroposterior (a) and lateral (b) views of the left femur showing wellaligned and united previous fracture site