This gap-n56-28 nail was inserted into a (b)(6) year-old overweight female patient with osteoporotic bone (weak bone).The femur presented with a narrow shaft and a valgus deformation.The failure occurred approximately three weeks post-surgery while the patient was sitting to put her shoe on.The weight of the patient (around 60 kg) was well above the weight limit of the nail, which is around 40 kg.Furthermore, the nail was inserted in retrograde instead of antegrade.Anterograde insertion is the preferred approach in patients with proximal fractures such as this case since it maximizes the resistance proximally where it is most needed.Retrograde insertion places the weakest section of the nail (the tip of the nail) proximally where the highest loads are experienced due to the proximity of the fracture or osteotomy and the lever arm of the hip.The surgeon had no choice but to insert the nail in retrograde due to specific patient conditions (distal osteotomy).The combination of high loads due to the patient being overweight and the retrograde insertion, caused the nail to fail proximally at the distal locking screw hole.The broken nail has been successfully retrieved and replaced for another nail with a larger diameter.
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