Peri-Implant Fractures Distal to an Antegrade Femoral Nail: A Case Series

Peri-implant fractures distal to an antegrade femoral nail are uncommon injuries, with no current consensus on the best treatment modality. We are presenting three cases of periimplant fractures distal to an antegrade femoral nail. All patients sustained an initial traumatic injury, which was managed with an antegrade femoral nail fixation. They subsequently suffer a second injury which causes periimplant fracture. Our first two patients were managed with removing the intramedullary nail followed by Less Invasive Stabilization System (LISS) plate fixation. In our third case, the intramedullary nail was left in-situ, and the fracture was fixed with a polyaxial locking plate We discuss their injury pattern, investigations and surgical management. Polyaxial locking plates show great promise in this setting as they allow fixation of the fracture whilst maintaining the existing nail to protect the entire femur from further injury.