Hip Pelvis.  2014 Jun;26(2):107-114. 10.5371/hp.2014.26.2.107.

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices

• Choi JY
• Sung YB
• Yoo JH
• Chung SJ

• KMID: 2054172
• DOI: http://doi.org/10.5371/hp.2014.26.2.107

Abstract

PURPOSE
To evaluate the factors affecting the bone union time and the occurrence of nonunion after intramedullary nailing of subtrochanteric femoral fractures in adults.
MATERIALS AND METHODS
We retrospectively reviewed data from 31 patients (22 men and 9 women) who had undergone femoral intramedullary nailing at least 1 year post-operatively and analyzed the bone union time, nonunion rates, and factors that affected the bone union time according to the fracture classification (AO and Fielding classifications), comminution of the medial cortex, reduction method, and additional cerclage wiring.
RESULTS
The average union time was 26.4 weeks. There were no differences in the bone union time according to the fracture classification, reduction method, or additional cerclage wiring. Significant differences were found in the bone union time between the medial cortex comminution and non-comminution groups. A relatively strong positive correlation was detected between the degree of post-operative displacement and the bone union time. Nonunion occurred in three cases and there was no failure of implants.
CONCLUSION
The bone union time was not affected by the reduction method nor additional cerclage wiring in intramedullary nailing of subtrochanteric femur fractures. Comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union.

Keyword

Subtrochanteric fractures; Intramedullary nailing; Ununited fracture

MeSH Terms

Adult
Classification
Femoral Fractures
Femur
Fracture Fixation, Intramedullary
Fractures, Ununited
Hip Fractures*
Humans
Male
Retrospective Studies

Figure

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  Fig. 1 (A) A 39-year-old female with right subtrochanteric femoral fracture was treated by proximal femoral nail antirotation and additional cerclage wirings. (B) Radiographic union was achieved at 1 year follow-up.

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  Fig. 2 (A) A 75 year-old female with right subtrochanteric femoral fracture was injuried by traffic accident. (B) The patient was treated by proximal femoral nail after closed reduction. Postoperative radiograph at 9 months shows nonunion. (C) A follow-up radiograph at 2 years shows bone union after revision surgery with locking compression plate fixation and autogenous iliac bone graft.

• 

  Fig. 3 Comparison of Bone Union Time and Non-union Rate

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