DOI: https://doi.org/10.36347/sasjs.2026.v12i07.002

Pages: 592-595

Introduction: Secondary fractures occurring in the vicinity of pre-existing implants represent a challenging surgical entity. Retained hardware from prior osteosynthesis alters the mechanical environment of the bone, creating stress concentration zones that predispose to new fractures. We report the case of a 48-year-old man who sustained a subtrochanteric fracture of the left femur at the proximal end of a plate implanted 33 years earlier for a proximal femoral fracture, and who was successfully managed with removal of the pre-existing plate and dynamic hip screw (DHS) fixation. Case Presentation: A 48-year-old male patient, with a history of proximal femoral fracture treated in 1993 by internal fixation with a lateral plate, presented following a road traffic accident with a closed injury of the left lower limb. Clinical examination revealed a painful, functionally impaired left lower limb with intact distal neurovascular status. Plain radiographs demonstrated a subtrochanteric fracture of the left femur at the proximal extremity of the pre-existing plate, consistent with a periprosthetic pattern at the implant tip. The patient was managed surgically with removal of the pre-existing plate followed by dynamic hip screw (DHS) plate fixation. Intraoperative fluoroscopic control confirmed satisfactory reduction and implant positioning. Conclusion: Periprosthetic fractures at the tip of retained femoral plates are a well-recognised but underreported complication of long-standing implants. The stress-riser effect at the implant extremity significantly increases fracture risk following even minor trauma. Surgical management must account for the pre-existing hardware; in this case, removal of the retained plate followed by DHS plating provided stable fixation. Surgeons should maintain awareness of this complication pattern in patients with retained implants.