Iatrogenic femoral neck fracture during antegrade intramedullary nailing: A case report and review of the literature

Abstract

Introduction: Anterior intramedullary nailing is the standard treatment for diaphyseal fractures of the femur in adults. This common treatment is not without complications, both general and specific to the technique used. We report a case of a rare iatrogenic fracture of the femoral neck during anterograde nailing of the femur. The aim is to raise awareness of the importance of rigorous technique and increased vigilance in our working conditions. Case report: a 24-year-old male patient, previously able to walk independently, was involved in a road traffic accident. This accident caused a fracture of the right femur classified as 32A3 according to AO/OTA. Treatment consisted of osteosynthesis using dynamic locked intramedullary nailing without fluoroscopic guidance and without any intraoperative incidents or difficulties. Immediate post-operative radiographic examination showed good realignment of the bone fragments and stable fixation, but also revealed that the entry portal of the nail was too medial and that there was an additional basicervical fracture classified as garden iii. Surgical management was performed using double percutaneous screw fixation, with favourable results at the 3-month follow-up. Conclusion: Iatrogenic fracture of the femoral neck during antegrade intramedullary nailing is an intraoperative complication that surgeons deserve to be well aware of.