Salvage Total Hip Arthroplasty After Cephalomedullary Nail Failure Due to Nonunion in a Pertrochanteric Fracture: A 10-Year Follow-Up

Cephalomedullary nailing is a widely used treatment for pertrochanteric fractures because of its minimally invasive nature, low complication rate, and biomechanical advantages. However, nonunion remains a rare but severe complication that can lead to implant failure and eventual nail breakage. We report the case of an 81-year-old patient who presented with implant failure following fixation of a pertrochanteric fracture with a Gamma cephalomedullary nail. Postoperatively, the patient developed nonunion, and nail breakage occurred 13 months after the initial surgery. Management was further complicated by the patient's refusal of an allogeneic blood transfusion. The broken nail was removed, and the patient successfully underwent a cementless total hip arthroplasty. At the 10-year follow-up, a clinical examination confirmed excellent functional recovery, and plain radiographs showed stable implant fixation with no evidence of loosening or other complications. This case highlights that conversion to total hip arthroplasty following nonunion-related Gamma nail breakage is a viable and effective option in elderly patients, providing long-term pain relief and stable implant survival, even in the absence of allogeneic blood transfusion.