Break in the lag: A unique mode of failure of TFNA® lag screw in an intertrochanteric fracture non-union
Keywords:
Implant failures; intertrochanteric fractures; non-union; TFNA; lag screw breakageAbstract
Intertrochanteric or pertrochanteric fractures of the femur are frequently encountered injuries that are often treated surgically to facilitate earlier mobility and improved outcomes. With a significant volume of these being encountered in an elderly population, these needs robust fixation and intramedullary nails (cephalomedullary) are often consider as the treatment of choice. Implant failures though relatively low are however not infrequent.
We describe a case of a 91-year-old lady presenting with cephalic lag screw break through the fenestrations of a Trochanteric Fixation Nail -Advanced (TFNA, DePuy-Synthes®) associated with intertrochanteric fracture non-union, following an unwitnessed ground level fall. This was 11 months after sustaining a proximal femur AO/OTA 31-A2.2 fracture for which she underwent TFNA fixation at a different hospital. Subsequently she underwent broken implant extraction and salvage total hip replacement with bone grafting and made a successful recovery.
The case report highlights a rare type of implant fracture of cephalomedullary nails through the lag screw fenestrations which can be catastrophic and difficult to manage in elderly populations. This also emphasises the need to monitor implants for newer modes of failure and report such cases when encountered for the better understanding of the orthopaedic and trauma community.
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