Minimally invasive fixation of a peri-implant femoral neck fracture without nail removal: A case report

We present the case of a 53-year-old female patient with a peri-implant transcervical femoral fracture associated with an intramedullary nail (IMN) implanted over 10 years ago following a low-energy fall from standing height. The preexisting implant constrained traditional surgical options due to the risks associated with nail removal, such as iatrogenic fractures and soft tissue damage. Closed reduction assisted by a traction table was performed, followed by internal fixation with cannulated screws in an inverted triangular configuration, preserving the preexisting implant and avoiding surgical complications. Clinical and functional follow-up demonstrated a satisfactory recovery. At 6 weeks, the Harris Hip Score (HHS) and Oxford Hip Score (OHS) indicated moderate recovery, with progressive improvement reaching excellent scores at 1 year (HHS: 96, OHS: 46). This case highlights the feasibility of cannulated screws as a minimally invasive and effective strategy for peri-implant transcervical fractures, maximizing patient benefits while minimizing surgical risks.