# 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.

## Key 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.