From Bad to Disaster: Iatrogenic Fracture Followed by Knee Perforation With Bone Fragments During Femoral Nailing

Intramedullary nailing is the preferred treatment method in tibial, femoral shaft, and sub- or intertrochanteric fractures. Despite good results, a number of complications have been well-characterized. Joint perforation by bone fragment during nail insertion is one such complication. We report an eventful case of a 63-year-old female patient who presented with an intertrochanteric fracture. Osteosynthesis with a short proximal femoral nail was complicated by a well-known and recognized on-time complication - an iatrogenic fracture of the femoral shaft. However, it was further complicated by knee arthrodesis by a bone fragment when a long nail was inserted. The bone fragment not only “closed” the knee joint, but fractured the medial tibial condyle and protruded into the medial soft tissues of the joint. This misfortune was not recognized intraoperatively and led to revision surgery in the short term and joint post-traumatic arthrosis with resultant total knee replacement in the long term.