Peri-Implant Subcapital Femur Fracture Post Cephalomedullary Nail Fixation

Presentation: A 65-year-old female with a prior right-sided cephalomedullary nail fixation for a pertrochanteric neck of femur fracture fell from a gate onto her right hip. She was unable to weight-bear on her right leg and presented to the emergency department. Diagnosis: X-ray imaging in the emergency department diagnosed a peri-implant subcapital neck of femur fracture at the base of the lag screw threads. Treatment: After evaluation of multiple treatment options, the patient was managed conservatively with physiotherapy, progressive weight-bearing and bone protection interventions. Discussion: An unusual case of a peri-implant femoral neck fracture that is not well described by current classification systems is presented. This case presents interesting questions in the management of a rare complication of cephalomedullary nailing.