Complex ipsilateral segmental femur fracture involving subtrochanteric and distal femur: successful management with combined IM nail and lateral plate

Abstract

Ipsilateral segmental femur fractures involving both the subtrochanteric and distal femur regions are rare high-energy injuries that present significant challenges in achieving stable fixation, maintaining alignment, and enabling early rehabilitation. We report the case of a 40- year-old male who sustained a complex ipsilateral segmental femur fracture following a high- velocity road traffic accident. Radiographic evaluation revealed comminated fractures involving the subtrochanteric region and distal femur. The patient was hemodynamically stable and had no associated life-threatening injuries. Surgical management consisted of closed reduction and intramedullary interlocking nailing for the subtrochanteric fracture, combined with open reduction and internal fixation of the distal femur using a lateral locking compression plate. A deliberate nail-plate construct was created by passing a distal interlocking screw of the intramedullary nail through the distal femur plate to improve overall construct stability. Early postoperative mobilization was initiated. Serial follow-up radiographs demonstrated satisfactory alignment and progressive callus formation at both fracture sites. The patient achieved good hip and knee range of motion and successfully returned to routine daily activities. This case highlights that a combined intramedullary nail and lateral plate construct provides superior biomechanical stability in ipsilateral subtrochanteric and distal femur fractures, facilitating early rehabilitation and favorable functional outcomes.