Missed Distal Femoral Cortical Perforation During Intramedullary Nailing of an Intertrochanteric Femur Fracture: The Role of Early Advanced Imaging

Distal femoral anterior cortical perforation is a rare complication of intramedullary nailing for proximal femur fractures. Awareness and intraoperative preventive measures are key to minimizing the risk of this complication. We report a case of a patient who experienced an anterior cortical breach of the distal femur during routine antegrade nailing for an intertrochanteric fracture, which was attributed to a sclerotic lesion in the distal femur. Additionally, we describe the management of this complication, along with an analysis of risk factors and effective prevention strategies.