Healing Against the Odds: Successful Bone Union in Intertrochanteric Femur Fracture Despite Z-Effect and Implant Failure.

Abstract

Introduction: Intertrochanteric femur fractures are common in the elderly, often resulting from low-energy trauma such as falls. Standard treatment typically involves internal fixation, which generally leads to good outcomes. However, complications like the Z-effect, where proximal screws of an intramedullary nail migrate in opposite directions, and implant failure can significantly impact healing.

Case report: A 58-year-old male patient sustained an intertrochanteric femur fracture following a fall. The fracture was treated with an intramedullary nail. Postoperatively, the patient developed the Z-effect, characterized by the migration of proximal screws in opposite directions. Subsequently, the implant failed, resulting in a broken nail and screw. Despite these complications, radiographic evaluations over time revealed progressive healing, and the patient eventually achieved complete bony union.

Conclusion: This case underscores the potential for successful bone healing even in the presence of significant complications such as the Z-effect and implant failure. The patient's complete bony union despite these challenges emphasizes the importance of diligent follow-up and adaptive management strategies in orthopedic practice. This case contributes to the understanding of fracture healing dynamics and highlights the resilience of bone healing mechanisms.