Subcapital femoral neck fractures are a rare complication after fixation of an intertrochanteric fracture with a proximal femoral nail. We report 2 such cases where the patients had severe osteoporosis, based on Singh's index and pathological findings. In one case there was a technical error leading to a tip-apex distance of more than 20 mm, but osteoporosis appeared to be a more significant cause than any technical problems.
SinghMNagrathARMainiPS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am1970;52:457–67.
2.
RossPMKurtzN. Subcapital fracture subsequent to Zickel nail fixation: A case report. Clin Orthop Relat Res1980;147:131–3.
3.
BakerDM. Fractures of the femoral neck after healed intertrochanteric fractures: A complication of too short a nail plate fixation. Report of three cases. J Trauma1975;15:73–81.
4.
MarianiEMRandJA. Subcapital fractures after open reduction and internal fixation of intertrochanteric fractures of the hip. Report of three cases. Clin Orthop Relat Res1989;245:165–8.
5.
ChanKMTsePY. Late subcapital fracture of the neck of the femur—a rare complication of Ender nailing. J Trauma1986;26:196–8.
6.
CameronHUPilliarRMHastingsDEFornasierVL. Iatrogenic subcapital fracture of the hip: A new complication of intertrochanteric fractures. Clin Orthop Relat Res1975;112:218–20.
7.
LungYTKamWLLeungYFChungOMWaiYL. Subcapital femoral neck fracture following successful trochanteric fracture treatment with a dynamic hip screw: A report of five cases. J Orthop Surg (Hong Kong)2007;15:238–41.
HesseBGachterA. Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg2004;124:692–8.
10.
AuneAKEkelandAOdegaardBGrogaardBAlhoA. Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthop Scand1994;65:127–30.
11.
BridleSHPatelADBircherMCalvertPT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br1991;73:330–4.
12.
HalderSC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br1992;74:340–4.
13.
ArringtonEDDavinoNA. Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: A case report and review of the literature. Am J Orthop1999;28:517–21.
14.
BonamoJJAccettolaAB. Treatment of intertrochanteric fractures with a sliding nail-plate. J Trauma1982;22:205–15.
15.
DoppeltSH. The sliding compression screw—today's best answer for stabilization of intertrochanteric hip fractures. Orthop Clin North Am1980;11:507–23.
16.
BaumgaertnerMRCurtinSLLindskogDMKeggiJM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am1995;77:1058–64.
17.
BaumgaertnerMRSolbergBD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br1997;79:969–71.
18.
HoriuchiTIgarashiMKarubeSOdaHTokuyamaHHuangT. Spontaneous fractures of the hip in the elderly. Orthopedics1988;11:1277–80.