Low trochanteric fractures in the presence of knee arthroplasty: The role of intermediate length cephalomedullary nail

Objectives: Despite the increasing popularity of intermediate-length cephalomedullary nails (ILCMNs), no studies reported their special role in situations involving distal femoral implants. This study highlights the use of ILCMNs in patients with low trochanteric fractures and total knee arthroplasty (TKA), where short or long nails were not utilized due to the fracture configuration or the presence of femoral implants, respectively. Methods: Out of 2621 cephalomedullary nails (CMNs) that were reviewed for this study, eight cases (8 females, mean age 77.8 years) developed low intertrochanteric fractures (AO/OTA 31 A2.3 or A3) in the presence of a stemmed (5 cases) or unstemmed (3 cases) TKA. All cases received 235 mm ILCMNs and four had an additional overlapping fixation with plates. Results: All the cases achieved radiographic bony union at a mean of 13.2 weeks postoperatively. After a mean follow-up of 52.3 months, none of the cases developed inter-prosthetic fractures or required revision. Conclusion: ILCMNs can be utilized as alternatives to long CMNs whenever knee arthroplasty is present.