Inverted L osteotomy and Dynamic Hip Screw Fixation without Bone Grafting for Primary Nonunion of Intertrochanteric Fracture of Femur; a Case Report

Abstract

Primary nonunion of intertrochanteric fractures is rare due to the excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). There is only one published series that exclusively describes seven primary nonunions of intertrochanteric fractures. We present a case of a 2 year old neglected primary non union of intertrochanteric fracture in a 43 year old male which was managed by heavy skeletal traction followed by an inverted L osteotomy of the distal fragment with DHS (Dynamic Hip Screw) fixation using the distal peg to fit into a trough made into the proximal fragment. No bone grafting was done and the fracture united at 21 weeks.