Abstract
INTRODUCTION: This case report describes two patients with unstable intertrochanteric (IT) fractures and coronal splitting of the greater trochanter (GT), resulting in primary failure of fixation. Radiographs and 3D computed tomography scans showed a comminuted GT fracture in one patient and a large coronal split in the other. CASE REPORT: Intramedullary fixation was initially attempted but failed intraoperatively due to the loss of lateral cortical support because of the coronal split, requiring supplemental anterior plating along with a proximal femoral nail anti-rotation-2. CONCLUSION: This highlights that despite using cephalomedullary nails, certain unstable fracture patterns may require additional fixation methods to prevent failure of fixationand achieve successful outcomes. This case report presents an effective strategy for managing such challenging fractures.