The Off-Label Use of a Humeral Nail To Treat a Subtrochanteric Femur Fracture: A Case Report

Abstract

The use of humeral nails for femoral subtrochanteric fractures is rarely reported. We present a case in which a humeral nail was employed for a subtrochanteric femur fracture alongside contralateral prophylactic stabilization of the femoral neck and shaft. A 29-year-old female patient with a history of bilateral varus-producing proximal femoral osteotomies, complicated by symptomatic hardware indicating bilateral removal, sustained a subtrochanteric fracture. Given her 98-degree neck-shaft angle, a humeral nail was selected for right femur fixation. She also underwent prophylactic stabilization of the contralateral proximal femur with a humeral nail. There are limited options for addressing subtrochanteric femur fractures in patients with anatomy variations that preclude using standard femoral nails. This case demonstrates the successful off-label use of a humeral nail for subtrochanteric femur fracture when a traditional femoral nail is impossible.

Keywords: congenital hip dysplasia; femoral neck osteotomy; femoral neck-shaft angle; im nail; subtrochanteric femur fracture.

Figure 1. Pre-fracture X-ray showing the neck angle and deformities from the removed hardware

Figure 2. Subtrochanteric right femur fracture

Figure 3. Post-op imaging of the right hip with a humeral nail

Figure 4. Post-op imaging of the left hip with a humeral nail

Figure 5. Most recent imaging showing radiographically healed fracture and intact hardware