Abstract
We report unusual subtrochanteric non-union and metalwork failure after an index procedure of a trochanteric entry-point-locked cephalomedullary nailing. We treated this non-union case successfully with the exchange of a thicker and longer intramedullary (IM) nail, supplemented by autologous iliac crest bone graft and bone morphogenic protein 7 (BMP-7). We think the success is due to the optimisation of the mechanical environment (the revision of fixation) along with the enhancement of the biological pathways of bone healing. A single stage surgical revision can be used for recalcitrant atrophic non-union fracture with implant failure.
Highlights
Subtrochanteric fractures account for 10-34% of all hip fractures, affecting young patients following high-energy trauma and older patients after low-velocity trauma, secondary to osteoporosis or metastatic pathological lesions [1,2]
We report one case of unusual subtrochanteric non-union fracture and metalwork failure after an index procedure of a trochanteric entry-point-locked cephalomedullary nailing
After insertion of the nail, open reduction was performed for the displaced fragment and an attempt was made to put in two cerclage wires (Figure 2)
Summary
Subtrochanteric fractures account for 10-34% of all hip fractures, affecting young patients following high-energy trauma and older patients after low-velocity trauma, secondary to osteoporosis or metastatic pathological lesions [1,2]. The overall incidence of nonunion, or delayed union, of subtrochanteric fractures and subsequent failure for any type of fixation, varies from 7% to 20% [3,4]. We report one case of unusual subtrochanteric non-union fracture and metalwork failure after an index procedure of a trochanteric entry-point-locked cephalomedullary nailing. We treated this non-union case successfully with a single stage surgical revision by optimising the mechanical and biological environment
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