Subtrochanteric fractures can occur as a complication of CCS fixation for femoral neck fractures if screws are inserted too closely together, and can be managed by CCS removal and ENDER nail fixation.
Close screw proximity may raise early subtrochanteric fracture risk after CCS fixation; hypothesis-generating case report leaves optimal spacing open.
Internal fixation by use of cannulated cancellous screws is a common orthopaedic procedure. However, screw holes through the lateral cortex of the femur cause reduction of the strength of the bone. We studied 2 patients who sustained subtrochanteric fracture at the level of the distal screw after the osteosynthesis of femoral neck fractures with cannulated cancellous screws. Their aetiology, prevention, and management are discussed. It is recommended that CCS should be inserted as far as possible from another screw. If subtrochanteric fracture occurs, removal of CCS and osteosynthesis with ENDER nails is advised.
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Nishimura et al. (2000) studied this question.
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