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

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Bone healing

Background:

• Subtrochanteric nonunions present a significant challenge in orthopedic trauma.
• Current treatment options often involve bone grafting, which can lead to complications.
• There is a need for effective surgical techniques that promote healing without bone grafting.

Purpose of the Study:

• To evaluate the efficacy of a tensioned plate-nail construct in treating subtrochanteric nonunions.
• To assess the healing rate and functional outcomes following this surgical approach.
• To determine if bone grafting is necessary when using this construct.

Main Methods:

• Retrospective cohort study conducted at two urban trauma centers in India.
• Included patients with subtrochanteric fracture nonunions (AO/OTA 31 A3.1, 2, and 3) treated between 2015 and 2023.
• Assessed healing, neck-shaft angle, limb length discrepancy, Harris hip score, and lower extremity functional scale.

Main Results:

• The study included 46 patients (26 men, 20 women) with a mean age of 60 years.
• 96% of patients achieved nonunion healing with the tensioned plate-nail construct.
• Significant improvements were observed in neck-shaft angle, limb length discrepancy, Harris hip score, and lower extremity functional scale.

Conclusions:

• The tensioned plate-nail construct provides consistent healing for subtrochanteric nonunions.
• This technique significantly improves hip and lower limb function without the need for bone grafting.
• It represents a viable alternative for managing complex nonunion cases.