A Corticotomy-Assisted Extraction for a Rare 3-Part Broken Proximal Femoral Nail: A Case Report

Introduction: Delayed union, non-union, and unstable fixation can lead to fatigue fractures of orthopedic implants. Breakages typically occur at the fracture site or locking screw insertion, acting as stress concentration foci. This case report highlights a rare instance of a 3-part broken proximal femoral nail (PFN), extracted using a corticotomy-assisted method without knee joint violation.

Case report: A 45-year-old male patient with a subtrochanteric femur fracture, initially fixed with a short PFN, presented with non-union and a broken implant a year post-surgery. Radiographs revealed breakage at two sites, creating three nail pieces. During revision surgery, the proximal nail part was removed through standard extraction. The middle fragment was accessed and removed at the fracture site, and the distal part was extracted through a lateral cortical window using a beaded guidewire in a retrograde fashion, avoiding the knee joint. A long PFNA was subsequently inserted, and bone grafting was performed.

Conclusion: This case underscores a rare PFN failure pattern, with fractures at three sites. The corticotomy-assisted extraction technique preserved medullary canal integrity, minimized tissue damage, and maintained biomechanical stability. This approach offers a viable alternative to traditional methods, reducing complications and improving surgical outcomes.