Use of the 95-degree angled blade plate with biological and mechanical augmentation to treat proximal femur non-unions: a case series

Abstract

Background Intertrochanteric and subtrochanteric non-union are rare but challenging complications. In the present study, we investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions. Methods Between October 2015 and February 2021, a retrospective cohort study was conducted at our institution to investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions, following the mechanical failure of the first device. All the patients underwent a clinical and radiographic follow-up at 6 weeks, 3, 6, 9, 12 and 18 months; at each follow-up, a plain radiograph of the femur was performed and patients were assessed using Harris Hip Score (HHS) and the Short Form-12 (SF-12) questionnaire. Results From October 2015 and February 2021, 40 proximal femur non-unions were managed at our Institution. Fifteen patients out of forty (37.5%) met the inclusion criteria. The main data of the study are summarized in Table 1; patients’ mean was 57 years old (range 19–83); 10 males and 5 females were included in the study. All the patients completely healed clinically and radiologically at an average of 6.1 months (range 4–13). All these patients returned to their pre-injury mobility status. During an average follow-up period of 25 months (range 8–60), the observed complications included wound dehiscence, which was treated with a superficial surgical debridement, a below-the-knee deep vein thrombosis, and a blade plate failure 3 months after the first revision surgery. Conclusions This study shows the treatment of inter-and sub-trochanteric non-unions with a 95° blade plate, medial strut allograft, and bone autograft obtained with RIA system, together with a varus malalignment correction, leads to a high percentage of bone healing, with a low incidence of complications and good clinical outcome.

Functional and Radiological Results Following Revision Blade Plating and Cephalomedullary Nailing in Aseptic Trochanteric and Subtrochanteric Nonunion

“…The functional results of this study demonstrated statistically significant differences regarding the Harris Hip Score with higher values in the nail group compared with the blade plate group. This is in line with recent studies reporting that the Harris Hip Score demonstrated good results for both treatment concepts but indicating that cephalomedullary nailing was superior compared with extramedullary fixation methods [21,37].…”

From Koch’s Bone Biomechanical Analysis to Contemporary Proximal Femur Fracture Management

“…As mentioned, the subtrochanteric region vasculature is precarious and could lead to delayed fracture consolidation, or non-union even in the latest reports on using IMN (7 -20%) [41]. However, for such complications, fixed-angle blade plates offer a reliable option for revision surgery with a high union rate [42]. It allows the removal of soft tissue interposition at the fracture interval, correction of malalignment, and addition of graft augmentation and compression.…”

“…It allows the removal of soft tissue interposition at the fracture interval, correction of malalignment, and addition of graft augmentation and compression. A recent intertrochanteric and subtrochanteric nonunion management literature review of 289 cases found that 65.7% of them were treated with a blade plate (61.6% were 95-degree angle), and the union rate ranged from 91 -100% [42].…”

Research Progress of Surgical Treatment of Subtrochanteric Fracture of the Femur

“…Therefore, at present, Angle plates are not used as the first choice for the first surgical treatment of subtrochanteric fractures, and are often used in revision surgery for non-union of subtrochanteric fractures. Vicenti [7] et al used 95-degree Angle plates to treat 15 patients with intertrochanteric and subtrochanteric fractures after nonunion. A follow-up of 6 months showed a high rate of postoperative fracture union, a low incidence of complications, and a good clinical outcome.…”