12/08/2025
Challenging Proximal Femur Fracture in an Older Adult — Choosing the Right Operation the First Time
Too often, displaced femoral neck or intertrochanteric fractures in older patients are treated with nails—and many of these cases ultimately fail, leading to painful delayed conversions or progressive osteoarthritis. Patients lose precious mobility, experience prolonged pain, and frequently face a second major operation that could have been avoided.
This case is a great reminder that primary arthroplasty with thoughtful femoral reconstruction can be the more definitive, durable solution when bone quality, fracture pattern, and patient demands warrant it.
🦴 Key teaching points from this case:
1. Use a primary stem rather than a Wagner-style or revision implant—the right stem geometry can provide immediate stability while minimizing unnecessary complexity.
2. Plan fixation proactively: formal calcar reconstruction and prophylactic cerclage fixation protect the femur during and after implantation.
3. Capture the iliopsoas with FiberWire/Ethibond and incorporate it into your calcar repair to restore tension and improve postoperative function.
4. Avoid the need for a trochanteric plate by creating a FiberWire tension band through the cerclage and gluteus medius—maintaining stability while minimizing hardware burden.
“Humpty Dumpty counted to ten Humpty Dumpty built up again All the king's horses and all the king's men Are happy that Humpty is together again”
