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Plate-Nail Construct Using a Realign, Compress and Nail Strategy Without Supplemental Bone Grafting for
Ashok S Gavaskar1, Parthasarathy Srinivasan, Prakash Ayyadurai
1Institute of orthopedics and trauma, Rela Hospital, Chennai, India .
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.
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