Iatrogenic subtrochanteric fracture: a complication of Zickel nails.

We studied the cases of four patients who sustained a fresh femoral subtrochanteric fracture during late removal of a Zickel nail that had been inserted for treatment of a fracture. The configuration of the intramedullary device appeared to be a significant factor in the production of the complication. Comminution of the proximal part of the femur (sufficient to require supplementary fixation with interfragmentary screws) and relative youth of the patient may increase the incidence of the complication.