Plate-tensioned reconstruction nail for proximal femur diaphyseal nonunion

A "plate-tensioned nail" implant construct is described as a single-stage salvage procedure for proximal femur diaphyseal nonunion. This construct combines the stability of a medullary nail with the compression afforded by a tension band, permitting immediate full weight bearing. The proximal hole of a 4.5-mm plate is modified to accept a 6.5-mm recon screw placed through the plate and nail into the femoral neck and head. Plate-based compression or an articulated tensioning device is used to compress across the nonunion site while affixing the plate to the lateral femoral diaphysis. Eight adults (7 men) of a mean age 49.5 years (range 19-81 years) with proximal femur diaphyseal nonunion were treated with a plate-tensioned nail construct supplemented with bone autograft (mean 27 cc, range 10-40 cc). The mean days to ambulation after repair was 1.1 (range 1-2). All patients progressed to clinical union within 4 months with no occurrence of mortality, implant failure, recalcitrant nonunion, periprosthetic fracture, or deep surgical site infection within 4 months (mean modified RUST score 13.6, range 12-16). One patient experienced a superficial surgical site infection at the bone graft harvest incision treated with oral antibiotics.