Clinical Details

Clinical and radiological findings:  A 56-year-old male experienced an industrial fall from a height of 3-5 meters, resulting in an isolated lower extremity injury. Neurovascular status was intact, and the injury was closed. The patient was a large and heavy-set individual. Initial trauma CT diagnotic revealed a transtrochanteric femoral fracture with a further long lateral wall fragment. The initial operative management by the on-call team included open reduction and cerclage fixation of the lateral wall, together with open clamp reduction of the proximal fracture fragment, followed by the introduction of a Gamma3 cephalomedullary nail. This initial approach achieved near anatomic fracture reduction and alignment without any appreciable varus nor significant rotational malreduction. The patient was managed FWB in the post operative period, and the inital XRs following ambulation demonstrated satisfactory retention of reduction. At 5 weeks post-operation, the patient presented with sudden atraumtaic pain and inability to bear weight, indicative of hardware failure. Imaging showed varus collapse and nail failure at the screw/nail junction.