Treatment of nonunion of the greater trochanter

Nonunion of the greater trochanter is an uncommon problem. Even when it occurs, many hips are sufficiently functional to obviate surgical intervention. When symptoms are significant and surgery appears necessary, firm fixation of the trochanter to an adequate bony bed is essential to achieve union. Pseudarthrosis at the site of nonunion must be excised down to viable bone, and near-perfect apposition to the femur must be achieved. Wiring must be performed carefully, the goals being adequate containment and firm fixation. Abduction stresses after surgery should be controlled; the security achieved at the time of reattachment is the only guide to the kind and degree of protection required. Although results in patients treated with early ambulation were not significantly different from those in patients with abduction splints or casts, the latter patients had been carefully selected; in certain cases, therefore, patients should receive prolonged treatment by abduction.