The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut
Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing.
Materials and methods
We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months.
The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG.
We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.
KeywordsSubtrochanteric complications Nail breakage Blade plate Allograft bone strut Non union Bone healing
Compliance with ethical standards
Conflict of interest
All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest includes employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.
Human and animal right
For this type of study is not required any statement relating to studies on humans and animals. All patients gave the informed consent prior being included into the study. All procedures involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments.
- 1.Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev 2008;(3):CD000337. doi: 10.1002/14651858.CD000337.pub2.
- 3.Wee JL, Sathappan SS, Yeo MS, Low YP. Management of gamma nail breakage with bipolar hemi-arthroplasty. Singap Med J. 2009;50(1):e44–e7.Google Scholar
- 6.Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee: Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90(4):700–7.CrossRefPubMedGoogle Scholar
- 9.Burnei C, Popescu G, Barbu D, Capraru F. Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures. J Med Life. 2011;14(4):324–9.Google Scholar
- 11.Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, Corradi A. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury. 2014;45 (Suppl 6):S93–7. doi: 10.1016/j.injury.2014.10.030.
- 13.Litrenta J, Tornetta P 3rd, Mehta S, Jones C, OʼToole RV, Bhandari M, Kottmeier S, Ostrum R, Egol K, Ricci W, Schemitsch E, Horwitz D. Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J Orthop Trauma. 2015;29(11):516–20. doi: 10.1097/BOT.0000000000000390.CrossRefPubMedGoogle Scholar
- 17.Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2015;135(6):811–8. doi: 10.1007/s00402-015-2206-x.CrossRefPubMedPubMedCentralGoogle Scholar