Femoral Neck Fracture Following Hardware Removal

Abstract

It is uncommon for femoral neck fractures to occur after proximal femoral hardware removal because age, osteoporosis, and technical error are often noted as the causes for this type of fracture. However, excessive alcohol consumption and failure to comply with protected weight bearing for 6 weeks increases the risk of femoral neck fractures.This article describes a case of a 57-year-old man with a high-energy ipsilateral inter-trochanteric hip fracture, comminuted distal third femoral shaft fracture, and displaced lateral tibial plateau fracture. Cephalomedullary fixation was used to fix the ipsilateral femur fractures after medical stabilization and evaluation of the patient. The patient healed clinically and radiographically at 6 months. Despite conservative treatment for painful proximal hardware, elective hip screw removal was performed 22.5 months after injury. Seven weeks later, he sustained a nontraumatic femoral neck fracture.In this case, it is unlikely that the femoral neck fracture occurred as a result of hardware removal. We assumed that, in addition to the patient's alcohol abuse and tobacco use, stress fractures may have attributed to the femoral neck fracture. We recommend using a shorter hip screw to minimize hardware prominence or possibly off-label use of an injectable bone filler, such as calcium phosphate cement.

Complications following implant removal in patients with proximal femur fractures – an observational study over 16years

“…Information about indication and complications for IR in healed proximal femur fractures can be seen as sparse in the current literature [1,2,[11][12][13][14]. When comparing the MIR with the NMIR subgroup, a statistical significant finding according to complications with 11.46% versus 28% was observed.…”

“…Indications and time interval for hardware removal in this special selected patient group is controversial in the literature [2,10,11,[13][14][15][16][17][18] neck fracture in the presence of fixation for intertrochanteric fractures, reports of ipsilateral femoral neck fractures after hardware removal from healed fractures are rare in the previous literature [9][10][11][12][13]18,19]. Secondary fractures after implant removal have a range from 27 to 44% in proximal femoral fractures [2,19], while other complications associated with IR are mechanical failure, pain and infection [12,14].…”

“…The majority of published papers on complications associated with proximal femoral fractures have focused on the different devices and procedures used for fixation [3][4][5][6][7][8][9]. Information of complications associated with implant removal in those studies can be seen as limited [1,2,[10][11][12][13][14].…”

Femoral Neck Fracture After Removal of the Compression Hip Screw From Healed Intertrochanteric Fractures

“…There is little information about the incidence of this type of fracture in the literature, whereas some retrospective studies reported a relatively high refracture rate after the plate removal from healed fractures. 10 As FNFs in the presence of fixation for an intertrochanteric fracture have been reported by several authors, it is possible that FNFs were present before hardware removal. The FNF after hardware removal from a healed intertrochanteric fracture has been reported incidentally in the literature.…”

A Novel Surgical Technique for Removing Buried Cannulated Screws Using a Guidewire and Countersink: A Report of Two Cases

“…The problem is further compounded when the initial screw was inserted percutaneously or via a minimally-invasive (MIS) technique. Multiple failed attempts at buried screw removal cause undue skin and soft tissue trauma from repeated manipulation and require more extensive incisions and bone loss, all of which could have obvious impact on the risk of wound complications, hardware breakage, iatrogenic fractures [ 10 , 11 ] and cosmesis [ 12 - 15 ].…”