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Case Reports
. 2024 Feb;14(2):82-87.
doi: 10.13107/jocr.2024.v14.i02.4226.

Peri-Implant Fracture Following Prior Fixation of Femoral Neck Fracture Using the Femoral Neck System: A Case Report

David Gregory  1 , Roy Small  1 , Michael Milshteyn  1   2 , Christopher Vitale  1   2
Affiliations
Case Reports

Peri-Implant Fracture Following Prior Fixation of Femoral Neck Fracture Using the Femoral Neck System: A Case Report

David Gregory et al. J Orthop Case Rep. 2024 Feb.

Abstract

Introduction: Peri-implant fractures (PIF) reported after cannulated screw and dynamic hip screw fixation historically occur distal to the implant within the subtrochanteric region secondary to the development of a stress riser. Newer implant designs for femoral neck fractures have attempted to combine the benefits of minimally invasive techniques without forgoing rigid angular stability but bring new potential complications.

Case report: We present a case of an intertrochanteric PIF in the setting of a non-displaced femoral neck fracture treated with the DePuy Synthes Femoral Neck System (FNS).

Conclusion: We present this case of a unique PIF pattern with the hope of identifying a potential complication associated with the novel FNS. Furthermore, we present a successful treatment option avoiding the need for conversion to hemiarthroplasty.

Keywords: Femoral neck fracture; femoral neck system; intertrochanteric fracture; peri-implant fracture.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
A 3-dimensionally constructed example of the Femoral Neck System (DePuy Synthes, West Chester, PA).
Figure 2
Figure 2
(a) Initial injury AP radiographs of the right hip (b) Computed tomography of the right proximal femur noting sclerosis of femoral neck (white arrow) concerning for femoral neck fracture.
Figure 3
Figure 3
(a) Threephase bone scan noting increased vascularity on blood pool image in the region of the femoral neck, with increased radiotracer uptake on delayed anterior (b) and posterior (c)images.
Figure 4
Figure 4
Post-operative radiographs demonstrating fixation of a non-displaced femoral neck fracture utilizing the femoral neck system.
Figure 5
Figure 5
Radiographic images demonstrating a displaced, peri-implant intertrochanteric femur fracture with an intact femoral neck system fixation device.
Figure 6
Figure 6
3D CT reconstruction imaging of 4-part peri-implant intertrochanteric hip fracture about the pre-existing femoral neck system.
Figure 7
Figure 7
Intraoperative fluoroscopic images demonstrating the use of a circular metal cutting diamond disc (Stryker) for removal of the distal cold-welded screw.
Figure 8
Figure 8
Intraoperative fluoroscopic image following short nail fixation of intertrochanteric PIF, noting cement augmentation within previous FNS antirotation screw path (white arrow).
Figure 9
Figure 9
3 week post-operative radiographic images demonstrating stable orthopedic hardware status post peri-implant fracture fixation.
See this image and copyright information in PMC

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References

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