Delayed Fixation of a Subtrochanteric Femur Fracture During a U.S. Navy Humanitarian Mission: A Case Report

This case highlights the successful surgical management of a subacute subtrochanteric femur fracture encountered during a U.S. Navy humanitarian mission aboard the USNS Mercy in Asia. It underscores the clinical, logistical, and ethical challenges of providing surgical care in resource-limited environments, contributing to the growing literature on military medicine and global health ethics. A 27-year-old male presented with a 1-month history of a right subtrochanteric femur fracture that had not been reduced or stabilized due to lack of surgical resources and financial constraints. He had remained wheelchair-bound and unable to ambulate. After careful evaluation by the Advanced Echelon (ADVON) Team and coordination with the Military Sealift Command, he was transported to the USNS Mercy for operative management despite challenging sea conditions. Open reduction and internal fixation with a reamed intramedullary nail and helical blade were performed aboard the ship under general anesthesia. The patient's postoperative course was uncomplicated, and he was discharged to local care on postoperative day 3. Seventeen months later, he was re-evaluated during a subsequent humanitarian mission and demonstrated complete fracture healing, independent ambulation, and no residual pain or complications. This case highlights the complexity of surgical and ethical decision-making in humanitarian and deployed environments. Achieving successful outcomes in these settings requires close interdisciplinary coordination, adaptability to operational constraints, and careful ethical consideration. Orthopedic surgeons involved in humanitarian missions must weigh patient benefit, procedural feasibility, and the local capacity for postoperative care when determining whether surgical intervention is appropriate.