Nonunion surgery of trochanteric fractures (AO 31-A2) with a sliding hip screw.

Abstract

Introduction Sliding hip screws (SHS) or cephallomedullary nails (CMN) are the fixation methods for proximal femur fractures (AO 31-A2). There is no consensus on the preferred treatment. 2-4% of these proximal femur fractures treated with a CMN develop a nonunion. Our objective was to review our results when replacing the CMN with a SHS in treating nonunion of trochanteric fractures. Method From 2013 until 2020, information was collected regarding all patients with a nonunion of a proximal femur fracture (AO 31-A2) that were initially treated with a CMN in a non-academic teaching hospital with a high volume of proximal femur fractures. All patients with a nonunion of the proximal femur fracture underwent an operation where the CMN was replaced with a SHS. Baseline characteristics were recorded, as well as union rate and complications regarding the secondary surgery. Results In total 15 patients were treated with removal of the CMN and placement of the SHS in the study period. 80% were female, average age was 72.3 years when primary surgery was performed. Most patients complained of pain during weight bearing due to the nonunion (N = 13). Mean time until revision surgery was 9.6 months. Consolidation of the nonunion was achieved in 93.3% of the cases. Pain relief was accomplished within 2 months. Complications were registered in 5 patients. Conclusion A SHS is an easy and effective secondary intervention when dealing with a nonunion of a trochanteric fracture (AO 31-A2) with high union rates without the necessity for bone grafting. Due to the higher complication rate in revision surgery, the patient should be well informed prior to surgery.