Nonunions after intertrochanteric and subtrochanteric femoral fractures

Abstract

The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite arelatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results. Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed. Atotal of 66patients were analyzed. The mean age was 58years (range 25-88years). The overall healing rate was 88% with amean consolidation time of 8months (range 2-29months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of adynamic hip screw (n = 1). The analysis of our treatment data as well as the current literature, revealed atrend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain apredictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in atargeted manner by acombination of mechanical and biological methods with areamed nail change to alarger caliber implant.