Intraoperative and postoperative subtrochanteric fracture of the femur associated with removal of the Zickel nail.

Twelve patients, whose ages ranged from twenty-one to sixty-eight years (mean, 32.6 years) and in whom a Zickel nail had been used to treat an acute traumatic subtrochanteric fracture of the femur, had fourteen subtrochanteric refractures that were associated with removal of the nail. The refracture was always different from the original fracture in type and site (being located an average of 4.3 centimeters distal to the lesser trochanter). Five of the refractures were recognized intraoperatively at the time of removal of the nail. Because of this potential complication, we believe that the Zickel nail should not be used in the treatment of subtrochanteric fractures of the femur in young patients.