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Updated: Apr 14, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Delayed Peri-Implant Trochanteric Femoral Fractures After Intramedullary Nailing: Surgical Challenges in an Aging
Shunsuke Suzuki1, Shunsuke Sato1, Takeru Yokota2,3
1Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan, fmu.ac.jp.
Introduction:
Fractures, including peri-implant femoral fractures, are increasing in aging populations. We present two trochanteric femoral fractures post-intramedullary nailing (IMN), highlighting preoperative planning for refracture risks and implant removal. These cases highlight potential surgical challenges in aging societies.
Patient #1:
The patient was a 91-year-old Japanese woman with a right trochanteric fracture, 10 years after IMN for a condylar open fracture. IMN removal was impossible; fixation used a dynamic hip screw. The fracture healed at 9-month follow-up.
Patient #2:
The patient was a 73-year-old Japanese man with a left trochanteric fracture, 14 years post-IMN for a shaft fracture. An intraoperative fracture occurred during IMN removal, requiring later revision surgery.
Discussion:
In elderly patients, fracture fixation should consider future refracture risks and implant removal needs. Experiences from Japanese orthopedics in a super-aged society offer insights for other aging populations.
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