Unusual mode of failure of intertrochanteric femur fracture fixation.

The dynamic hip screw fixation is a commonly used modality of treatment for intertrochanteric femur (ITF) fractures. Various modes of failure in an operated case of ITF fracture have been described. The most frequent mode of failure is screw cut-out through the head. Occurrence of mechanical failure is rare and usually involves the shaft of the plate. We describe an unusual case with failure at the barrel of the plate and hip screw. A middle-aged man with a previously operated ITF fracture presented with pain in the same hip. Radiographs revealed non-union of the fracture with an implant failure. Revision surgery was performed during which a unique mode of implant failure was found to have occurred. The barrel of the plate had broken resulting in a bent Richard's screw. This case underlines the importance of high stress failure in non-union as opposed to high cycle, low stress failure, which is more frequently seen.