Fig. 4

Forty-eight-year-old female patient sustaining a distal third femoral fracture (A). Surgical treatment of the same patient with blocked retrograde intra-medullary nail (B, C). DEXA scan 1 year after surgery showing osteoporosis at the level of the trochanters and femoral diaphysis (D). Femur X-ray 1 year after surgery shows femur demineralization of the proximal femoral third (E) and complete fracture union at the distal femoral third (F). Two months after the latest follow-up visit, the patient presented to the local hospital after a fall, complaining of ipsilateral hip pain. Femur X-ray and CT scan highlighted an undisplaced intertrochanteric fracture (G, H). CT scan cuts at the level of the greater trochanter (I), isthmus (J) and condyles (K) are compared with biomechanical studies belonging to Shih et al. [22] (L–N) and show shielding of the nail with stress applied to the intertrochanteric area. The intertrochanteric fracture was surgically managed with three cannulated screws. 6 months post-operation X-ray and CT scan showed fracture union (O, P)