{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:33:46Z","timestamp":1787308426316,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: Cement augmentation of cephalomedullary head elements can improve the purchase of osteoporotic bone; however, it does not eliminate the need for accurate implant positioning or the preservation of sliding. We report the case of an 87-year-old woman who underwent intramedullary nailing with a cement-augmented helical blade for intertrochanteric fracture. Methods: This is a single-patient case report. Calibrated radiographic measurements\u2014tip\u2013apex distance (TAD), calcar-referenced TAD (CalTAD), neck\u2013shaft angle (NSA), and telescoping\u2014were obtained immediately postoperatively and at 4, 7, 12, and 15 months. CT was performed at postoperative week 1 and at failure, and MRI was performed for clinical deterioration. In addition, a targeted narrative review summarizes the evidence on the head-element position, sliding behavior, reduction alignment, and augmentation. Results: Immediate postoperative indices were within the accepted targets: TAD 22.6 mm, CalTAD 22.8 mm, NSA 134\u00b0, with the head element inferior on the anteroposterior view and central on the lateral view. Rehabilitation proceeded with full weight bearing as tolerated. Early telescoping was minimal (3.8\u20133.9 mm). Between 7 and 15 months, progressive varus with shortening of TAD\/CalTAD and little additional telescoping was observed, radiographically consistent with relative proximal migration of the head\u2013cement complex and a cleavage plane along the inferior cement mantle, culminating in a subcapital femoral neck fracture with the implant in situ. Emphasis should be placed on accurate implant positioning and preservation of sliding capacity, because cement augmentation alone may not prevent mechanical failure when the implant position or load transfer is suboptimal. Conclusions: Cement augmentation stiffens the interface and reduces micromotion but does not neutralize malposition-induced stresses. Accurate positioning, preservation of sliding, and timely conversion when sliding fails to progress are advisable; these findings are hypothesis-generating from a single case. We propose a position- and sliding-based decision guide to support clinical decision-making; its usefulness remains to be validated in larger studies.<\/jats:p>","DOI":"10.3390\/clinpract16010001","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T11:30:18Z","timestamp":1766489418000},"page":"1","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subcapital Femoral Neck Fracture Despite Cement-Augmented Cephalomedullary Nail Fixation for an Osteoporotic Intertrochanteric Fracture: A Case Report and Position- and Sliding-Based Decision Guide"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1678-8763","authenticated-orcid":false,"given":"Suguru","family":"Yokoo","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukimasa","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyotaro","family":"Ohno","sequence":"additional","affiliation":[{"name":"Department of Pathology, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiko","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuji","family":"Terada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiya","family":"Yamana","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuyama City Hospital, Hiroshima 721-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"38560","DOI":"10.52965\/001c.38560","article-title":"Cephalomedullary nailing for reverse oblique intertrochanteric fractures 31A3 (AO\/OTA)","volume":"14","author":"Marsillo","year":"2022","journal-title":"Orthop. 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