A Second Non-prosthetic Peri-Implant Femoral Fracture (PIFF) Following Plating for a Primary PIFF After a Trochanteric Femoral Fracture

TL;DR

An 83-year-old woman experienced a second non-prosthetic peri-implant femoral fracture after initial treatment, highlighting the importance of initial surgical choices in preventing future fractures.

Contribution

This is the first reported case of a second non-prosthetic peri-implant femoral fracture following treatment of an initial fracture.

Findings

A second PIFF occurred distal to a lateral femoral plate used after initial fracture treatment.

Use of a long distal femoral plate with a locking attachment plate achieved strong fixation and successful recovery.

Initial treatment choices for PIFFs may influence the risk of subsequent fractures.

Abstract

Due to the increasing number of patients with osteoporosis, proximal femoral fractures are on the rise in Japan's super-aging society. With the widespread adoption of surgical treatment and improved prognosis, the number of patients surviving for a long time after surgery has increased, and the occurrence of non-prosthetic peri-implant femoral fractures (PIFFs) is also trending upward. To our knowledge, there have been no previous case reports of a second PIFF after an operation for a PIFF. We report a case of an 83-year-old woman who sustained a second PIFF after surgery for a trochanteric femoral fracture. The initial fracture was treated with a short cephalomedullary nail. Although a bone union from the trochanteric fracture was obtained, a subsequent PIFF distal to the nail occurred and was fixed with a lateral femoral plate and cables. However, a second PIFF occurred again distal to the plate. In the surgery for the second PIFF, we used a long distal femoral plate that covered the entire femur along with a locking attachment plate (LAP). This achieved a strong fixation, and the patient had a good postoperative course, with bone union confirmed at four months, and she became able to walk with a cane. This case suggests that the choice of treatment for the first PIFF influences the risk of subsequent refracture. The LAP used in this case is considered a useful treatment option for preventing a second PIFF, as it allows for strong fixation while preserving the existing implant. In a super-aging society where the possibility of multiple PIFF is increasing, it is important to carefully select the initial treatment.

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