Overlapping with a nail-cable-plate system construct as treatment for peri-implant proximal femur fracture. Case report.

Abstract

In frail elderly patients, falls are the main cause of visits to the emergency department. One-third of people ≥65 years of age will suffer a fall each year, and fractures occur in 1-5% of these patients, with fractures of the proximal femur being very common. The incidence of proximal femoral fractures continues to rise, as does the incidence of recurrent falls and recurrent fractures, known as peri-implant and peri-prosthetic fractures. The literature rarely reports these injuries, so there is no standardization in treatment.

We present the case of a 92-year-old female patient, 20 months after intramedullary nailing due to pertrochanteric fracture of the right femur, who suffered a new fall and re-fracture of the proximal femur, of the peri-implant type. Due to the osteopenia detected, and taking into consideration the level of activity of this patient, a novel fracture synthesis construct combining nail-cable-plate system was decided to be applied, under the principle of  overlapping of implants, reaching satisfactory results and a full return to regular daily activities. It was concluded that the application of this principle is safe and reproducible, nevertheless, treatment must be tailored in these rare fracture patterns/ pathologies, considering the biomechanical demands of the patient.