Subtrochanteric fractures following Gouffon pinning of subcapital femoral fractures.

Of the first 158 patients in a series of 292 consecutive patients treated for a femoral neck fracture with multiple pinning according to Gouffon's method (Howmedica Inc.), four (2.5 per cent) subsequently suffered a subtrochanteric fracture at the site of the distal pins. The configuration of the fractures was identical. These fractures occurred spontaneously while walking, and one occurred after slight direct trauma. Re-osteosynthesis was required in all four cases using a screw-plate device. If necessary, one or two pins were left in place to secure rotational stability. After a review of these cases and the literature, various modifications to Gouffon's method were introduced, and none of the following 134 patients suffered secondary fractures.