A case study of subsequential intramedullary nails failure

Intramedullary nails increasingly applied in stabilization of long bone fractures due to their advantage regarding to conventional approach. Moreover, in cases of non union or mal union of fragments of the bone, the nail can be subjected to an expressive portion of the external loads at full weigh-bearing instances, which can promotes short term fatigue fracture of the nail. This paper shows a case of two successive failure of the nail in an individual, who experienced severe plastic strain in a first slotted, unlocked nail and short term fatigue fracture of the second non slotted, stiffer locked nail. The failure of the first one was due to low stiffness whereas the second was due to non union or mal union of the femur after three months. The risk of nail failure may be minimized by using nails that have a larger diameter or stiffness and by avoiding early weight-bearing as well as by adequate post-operatory follow-up during healing period.