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.