Subtrochanteric fracture after femoral neck system of femoral neck fractures: a report of four cases

• Published in: BMC musculoskeletal disorders 2023-09, Vol.24 (1), p.1-749, Article 749
• Main Authors: Fisher, John C, Gerzina, Christopher, Rush, Kaitlin, Caroom, Cyrus
• Format: Article
• Language: English
• Subjects: Biomechanics; Cardiovascular disease; Care and treatment; Case Report; Clinical outcomes; Complication of hip fracture treatment; Decision making; Development and progression; Diagnosis; Femoral neck fixation; Femoral neck fracture; Femoral neck system; Femur; Fractures; Hypertension; Injuries; Internal fixation in fractures; Methods; Musculoskeletal diseases; Pain; Patients; Peri-implant fracture; Systematic review; Transplants & implants; Trauma; Young adults
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06872-2

Background The femoral neck system (FNS) is commonly used for internal fixation of femoral neck fractures and has shown promising results. However, we have observed cases of peri-implant subtrochanteric femur fractures associated with the use of FNS at our institution. This case series aims to investigate four cases of peri-implant subtrochanteric fractures in patients treated with the FNS implant for femoral neck fractures. Case presentation We reviewed 35 patients who underwent treatment with FNS for femoral neck fractures between January 2017 and December 2021 at our level 1 trauma institution. Among these patients, four cases of peri-implant subtrochanteric femur fractures were identified. In contrast, no such fractures occurred in patients treated with cannulated screws or dynamic hip screws (DHS). Interestingly, all four cases of peri-implant fractures were seen in patients with incomplete nondisplaced femoral neck fractures. Only one case involved an identifiable technical error. Conclusions This case series sheds light on peri-implant subtrochanteric femur fractures as a previously unreported complication associated with the use of FNS for femoral neck fractures. These fractures were observed exclusively in patients with incomplete nondisplaced fractures who received FNS fixation. No similar complications were observed in patients treated with other types of fixation. This finding suggests the need for caution and further investigation when considering FNS as a treatment option for this specific fracture pattern. The identification of peri-implant subtrochanteric femur fractures as a potential complication of FNS usage in incomplete nondisplaced femoral neck fractures raises important considerations for clinical decision-making and patient management in orthopedic trauma. Keywords: Femoral neck fracture, Femoral neck system, Peri-implant fracture, Complication of hip fracture treatment, Trauma, Femoral neck fixation, Open reduction internal fixation femoral neck, Proximal femur fracture, Subtrochanteric femur fracture