Nail-Retaining Derotation Osteotomy for Subtrochanteric Fracture Malunion: A Case Report and Review of the Literature

Rotational malalignment is relatively common after intramedullary nailing of femoral fractures and may lead to significant clinical symptoms. Comminution, inherent differences in femoral version, and the absence of reliable clinical markers make achieving anatomical rotational reduction challenging, even for experienced surgeons. Various methods have been described to surgically correct rotational deformities, depending on the time elapsed since the original surgery and whether the fracture has already united. Both open and closed techniques have been used, along with different types of osteosynthesis hardware. We present a case of a subtrochanteric fracture malreduction fixed in 30° of internal rotation, which was corrected through an open femoral osteotomy using a Gigli saw while retaining the original nail three months after the index operation. This operative approach yielded optimal results in our case.