• Lauri M Halonen, Antti Stenroos, Henri Vasara, and Jussi Kosola.
• Department of Orthopedics and Traumatology, South Karelia Central Hospital, University of Helsinki, Valto Käkelän katu 3, 53130, Lappeenranta, Finland. lauri.halonen@eksote.fi.
• Arch Orthop Trauma Surg. 2022 Dec 1; 142 (12): 371537203715-3720.

IntroductionTrochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed.Materials And MethodsA single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared.ResultsThe total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union.ConclusionsA PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.© 2021. The Author(s).

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