A Method for Fixation of Femoral Fractures below Previous Hip Implants

Previously applied plates and screws or endoprosthetic implants of the proximal femur create a recurrent problem in surgery for fractures below such implants. Of 13 elderly women (mean age, 81 years) six had had a hip arthroplasty, five a nail and plate, and two a nail or a plate only. The fresh fractures were stabilized from the condylar region by intramedullary nails connected to a coupling-piece with two transverse screws preventing extrusion or intrusion of the nails. All fractures healed uneventfully without rotatory and angulatory malalignment. The maximum shortening was 2 cm in two patients and was less in the others. Patients walking before surgery were mobilized the day after. The system is more stable than Rush pins or Ender nails only and does not require good quality of bone needed for plating.