Plate-Nail Construct Using a Realign, Compress and Nail Strategy Without Supplemental Bone Grafting for Subtrochanteric Nonunions.

OBJECTIVES

To assess the healing rate and improvements in hip and lower limb function using a tensioned plate-nail construct without bone grafting in the treatment of subtrochanteric nonunions.

SETTING

Two urban trauma centers in India.

DESIGN

Retrospective cohort study.

PATIENT SELECTION CRITERIA: Patients from 2015 to 2023 operated for subtrochanteric fracture nonunions (AO/OTA 31 A3.1, 2, and 3) using a tensioned plate-nail construct without bone grafting.

OUTCOME MEASURES AND COMPARISONS: The primary outcome measure was healing of the nonunion after repair using the plate-nail construct without bone grafting. Secondary outcome measures were improvements in neck-shaft angle, limb length discrepancy, Harris hip score, lower extremity functional scale postsurgery, and the need for further surgical procedures.

RESULTS

The study cohort included 26 men and 20 women (46 patients) with a mean age of 60 years (range 29-82 years). The nonunion healed in 44 patients (96%) after fixation with the plate-nail construct. One patient needed another revision surgery to achieve healing. Significant improvements were seen in neck-shaft angle (127 ± 4.5 vs. 111 ± 7 degrees, P < 0.001) and limb length discrepancy (0.5 ± 0.4 vs. 1.5 ± 0.8 cm, P = 0.02) postsurgery. Functional assessment in 39 patients at a mean follow-up of 40 ± 20 months showed significant improvements in Harris hip score (85 ± 8 vs. 36 ± 8 points, P < 0.001) and lower extremity functional scale (66 ± 7 vs. 22 ± 6 points, P < 0.001).

CONCLUSIONS

Consistent healing with significant improvements in limb length, hip, and lower limb function were achieved using the plate-nail-assisted technique of realignment and nonunion compression without supplemental bone grafting in the treatment of subtrochanteric nonunions.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.