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Femoral neck fracture after healed open reduction internal fixation of an intertrochanteric fracture.

Femoral neck fracture is an uncommon complication after internal fixation of an intertrochanteric fracture that has healed, with many authors implicating poor placement of the fixation device as the cause.1–6 These reports describe intertrochanteric fractures treated with various devices, including compression hip screws that are commonly used for these injuries. When using this type of fixation, the depth of the implant into the femoral head has been implicated as a possible cause of fixation failure, especially in osteopenic bone.7 We report a case of a femoral neck fracture in a patient who previously had a successfully treated and well-healed intertrochanteric fracture, internally fixed with a compression hip screw and plate. Our case illustrates an aspect of screw placement that we think contributes significantly to the mechanism of injury of subsequent femoral neck fracture. In our patient, who had documented normal, healthy bone, new trauma resulted in a femoral neck fracture. We think that inadequate depth of placement of the prior screw rendered the femoral head vulnerable to fracture by allowing it to lever over the distal portion of the screw. This suggests that placement of the screw in the subchondral bone close to the articular surface may be the most important factor in preventing late posttraumatic fracture, regardless of bone quality.