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Open Access 16-01-2024 | Wound Debridement | Original Paper

The effect of valgus reduction on resistant subtrochanteric femoral non-unions: a single-centre report of twenty six cases

Authors: Barakat El-Alfy, Alaa Abououf, Ahmed Darweash, Salam Fawzy

Published in: International Orthopaedics | Issue 4/2024

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Abstract

Purpose

Re-revision of subtrochanteric non-unions is technically challenging and lacks robust evidence. The results of managing subtrochanteric fractures after multiple failed procedures have rarely been reported in the literature. This study aims to evaluate the effect of valgus reduction on non-united subtrochanteric fractures with single or multiple failed revision surgeries.

Methods

Twenty-six patients with aseptic subtrochanteric fracture non-union underwent failed single or multiple revision procedures after index fracture fixation surgery between 2011 and 2019. The exclusion criteria were as follows: septic non-union, peri-prosthetic, and pathological fractures. Lateral-based wedge valgus reduction and compression at the non-union site using a valgus-contoured DCS together with decortication, debridement, and bone grafting were used. The main outcome measurement was radiological union, pain, LLD, HHS, and restoration of pre-fracture activities.

Results

The mean follow-up was 4.5 years (range 3 to 7); prior revision surgeries range from two to five and union at 6.5 months (range 3 to 10) and the delayed union in one case and an infected non-union in one case. The mean LLD was 4 cm (range 3 to 5), which improved to 1.5 cm (range 1 to 4) (P-value < 0.001). The mean VAS was 7 (range 6 to 8), and 24 patients achieved painless ambulation without a walking aid after the union. The mean HHS was 40 (range 25 to 65), which improved to 85 (range 55 to 95) (P-value < 001), achieving 15 excellent, ten good, and one poor results.

Conclusion

Mechanical optimisation by lateral closing wedge and stable fixation with pre-contoured DCS with biological enhancement resulted in a successful outcome in recalcitrant subtrochanteric non-unions.
Literature
6.
Metadata
Title
The effect of valgus reduction on resistant subtrochanteric femoral non-unions: a single-centre report of twenty six cases
Authors
Barakat El-Alfy
Alaa Abououf
Ahmed Darweash
Salam Fawzy
Publication date
16-01-2024
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-023-06085-1

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