Background: Intertrochanteric femur fractures are a common orthopaedic injury that are often treated surgically. Cephalomedullary nails (CMN) are frequently the implant of choice for intertrochanteric femur fractures, resulting in low complication rates. Implant failure is a rare but reported complication. Common locations of failure include the proximal nail aperture, distal screw holes, and implant shaft. In this case report, we describe a CMN failure pattern through fenestrated cephalic screw holes.Case: A 70-year-old female sustained an OTA 31A-2.2 peritrochanteric fracture during a motor vehicle collision. She was treated the following day with a Synthes Trochanteric Fixation Nail-Advanced CMN utilizing a fenestrated cephalic screw. There were no intraoperative complications. She was made non-weight bearing for 8 weeks after the procedure due to ipsilateral foot fractures. At 6 months follow-up she was noted to have a delayed union. 11 months postoperatively she suffered a ground level fall and the cephalic lag screw failed through its fenestrations, resulting in varus collapse of her fracture at the femoral neck. The patient then underwent nail extraction and salvage total hip arthroplasty. Conclusion:Cephalomedullary nail implant failure is presented with implant fracture propagation through a fenestrated cephalic screw. Cephalomedullary lag screw failure is rare and can be difficult to manage. It is important to monitor new implants for unique failure mechanisms.

Background: Early (2020) reports on mortality in patients with coronavirus disease 2019 (COVID-19) who underwent orthopedic surgery ranged from 20.5% to 56%, but these studies included elderly patients with multiple comorbidities. The mortality rate for younger and asymptomatic COVID-19-positive patients undergoing orthopedic surgery after high-energy trauma is underreported. The purpose of this study was to compare the 30-day mortality of asymptomatic COVID-19-positive patients and COVID-19-negative patients surgically treated for orthopedic trauma at a Level I trauma center during the coronavirus pandemic. A secondary objective was to compare the patients' postoperative hospital course and length of stay. Methods: This study is a single-center retrospective review of all patients who underwent an orthopedic surgical procedure at a Level I trauma center during a 3-month period early in the COVID-19 pandemic. All patients received a preoperative nasopharyngeal swab to determine COVID-19 infection status. Preoperative demographic variables, perioperative and postoperative mortality within 30 days, length of stay, and intensive care unit days were compared between COVID-19-positive and COVID-19-negative patients. Results: Of the 471 total patients, 13 were COVID-19-positive and 458 were COVID-19-negative prior to surgery. The average age of all patients was 40.5 ± 19.8 years. The mortality rate in the COVID-19-positive group was 0% vs 0.7% in the COVID-19-negative group, with no significant difference between groups (P=0.77). The COVID-19-positive group vs the COVID-19-negative group had no significant difference in hospital length of stay (7.4 days vs 4.4 days, respectively, P=0.12). Conclusion: Asymptomatic COVID-19-positive orthopedic trauma patients treated with surgery at a Level I trauma center in a 3-month period during the COVID-19 pandemic had a 0% mortality rate, and we found no differences between COVID-19-positive and COVID-19-negative patients with respect to mortality and hospital length of stay.