Combined Mechanical and Biological Salvage of Recalcitrant Subtrochanteric Non-union using Valgus Osteotomy, Blade Plate Fixation, and Endomedullary Fibular Graft.

INTRODUCTION: Subtrochanteric femoral non-union after failed fixation is a demanding reconstructive problem because of high mechanical loads on the proximal femur and impaired bone biology following repeated surgery. Persistent varus deformity, loss of medial support, and implant failure frequently lead to recurrent non-union. Valgus correction converts shear forces into compressive forces across the non-union site, and structural fibular grafting can provide additional biological and mechanical support in complex proximal femoral reconstruction.

CASE REPORT: A 62-year-old male presented with recalcitrant subtrochanteric femoral non-union, implant breakage, and progressive varus deformity after three previous failed surgical procedures. He underwent a salvage procedure combining a lateral closing wedge valgus osteotomy, fixed-angle 110° blade plate fixation, and endomedullary structural fibular autografting through the existing cephalomedullary nail tract. The fibular graft restored an intramedullary biological and structural strut opposing residual varus deforming forces. Complete radiographic union was achieved at 9 months, and the patient remained pain-free and fully weight-bearing at 3-year follow-up, with no implant failure or recurrence of non-union.

CONCLUSION: Combined valgus closing osteotomy, fixed-angle blade plate fixation, and endomedullary structural fibular grafting can provide reliable mechanical stability and biological support, achieving successful salvage of recalcitrant subtrochanteric non-union after multiple failed prior procedures.