Delayed Peri‐Implant Trochanteric Femoral Fractures After Intramedullary Nailing: Surgical Challenges in an Aging Society: A Two‐Case Report

Introduction Fractures, including peri‐implant femoral fractures, are increasing in aging populations. We present two trochanteric femoral fractures post–intramedullary nailing (IMN), highlighting preoperative planning for refracture risks and implant removal. These cases highlight potential surgical challenges in aging societies. Patient #1 The patient was a 91‐year‐old Japanese woman with a right trochanteric fracture, 10 years after IMN for a condylar open fracture. IMN removal was impossible; fixation used a dynamic hip screw. The fracture healed at 9‐month follow‐up. Patient #2 The patient was a 73‐year‐old Japanese man with a left trochanteric fracture, 14 years post‐IMN for a shaft fracture. An intraoperative fracture occurred during IMN removal, requiring later revision surgery. Discussion In elderly patients, fracture fixation should consider future refracture risks and implant removal needs. Experiences from Japanese orthopedics in a super‐aged society offer insights for other aging populations.