Treatment of the failed intramedullary fixation using long cephalomedullary nail for atypical subtrochanteric femoral fractures

Intramedullary nails are widely used to manage subtrochanteric fractures, and they have good results. There are some documented cases of fixation failure, use a short nail to treat atypical subtrochanteric fractures. The less biomechanically sound fixation achieved by short nail will predispose to cause delayed union and implant breakage. There have been few reports in the literature of implant failure, use a long nail to treat the atypical subtrochanteric fracture. But we experienced two cases of implant failure caused by non-union: treatment with 95-degree condylar blade plate with autologous cancellous bone graft. We report two cases of failed fixation of the bisphosphonateassociated atypical subtrochanteric fractures treatment with long cephalomedullary nails and discuss the causes of the underlying failure mechanism