Locked nailing for shortened subtrochanteric nonunions: a one-stage treatment

Subtrochanteric nonunions may involve considerable shortening. A convincing method of concomitantly treating both combined disorders has not been reported. Twenty-three consecutive patients with these combined disorders were treated by femoral condylar skeletal traction, one-stage lengthening to 4 cm maximum, static locked nail stabilization, and corticocancellous bone grafting. Indications for this technique included subtrochanteric aseptic nonunions, patient younger than 60 years, and 2.0 to 5.0 cm shortening. Postoperatively, protected weightbearing ambulation was encouraged as early as possible. Twenty-one patients were followed for a minimum of 1.2 years (mean, 3.2 years; range, 1.2-6.7 years). All nonunions healed with a union rate of 100% (21 of 21) and a median union period of 4.0 months (range, 3.5-11 months). One nonunion healed at 11 months despite nail breakage. In all patients, hip function improved from unsatisfactory grades preoperatively to satisfactory grades at latest followup. Knee function grade remained satisfactory throughout the treatment course in all patients. Although no surgical technique has clearly proven superior in treating subtrochanteric nonunions associated with considerable shortening, the described approach may be the optimal treatment alternative. Protected weightbearing to reduce nail stress throughout the treatment course improves the success rate.

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.