“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”
Abstract Background Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debrid...
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doaj-2dc1ca1f170940fa886d95b14d89e2af2020-11-25T02:55:10ZengBMCBMC Musculoskeletal Disorders1471-24742018-12-0119111210.1186/s12891-018-2372-4“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw”Sebastian Lotzien0Valentin Rausch1Thomas Armin Schildhauer2Jan Gessmann3BG University Hospital BergmannsheilBG University Hospital BergmannsheilBG University Hospital BergmannsheilBG University Hospital BergmannsheilAbstract Background Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications. Methods We conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating. Results Between 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34–91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6–173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery. Conclusions The results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion.http://link.springer.com/article/10.1186/s12891-018-2372-4Subtrochanteric nonunionPseudarthrosisDCSDynamic condylar screwIntramedullary nailingHardware failure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sebastian Lotzien Valentin Rausch Thomas Armin Schildhauer Jan Gessmann |
spellingShingle |
Sebastian Lotzien Valentin Rausch Thomas Armin Schildhauer Jan Gessmann “Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” BMC Musculoskeletal Disorders Subtrochanteric nonunion Pseudarthrosis DCS Dynamic condylar screw Intramedullary nailing Hardware failure |
author_facet |
Sebastian Lotzien Valentin Rausch Thomas Armin Schildhauer Jan Gessmann |
author_sort |
Sebastian Lotzien |
title |
“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_short |
“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_full |
“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_fullStr |
“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_full_unstemmed |
“Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
title_sort |
“revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw” |
publisher |
BMC |
series |
BMC Musculoskeletal Disorders |
issn |
1471-2474 |
publishDate |
2018-12-01 |
description |
Abstract Background Nonunions of the subtrochanteric region of the femur after previous intramedullary nailing can be difficult to address. Implant failure and bone defects around the implant significantly complicate the therapy, and complex surgical procedures with implant removal, extensive debridement of the nonunion site, bone grafting and reosteosynthesis usually become necessary. The purpose of this study was to evaluate the records of a series of patients with subtrochanteric femoral nonunions who were treated with dynamic condylar screws (DCS) regarding their healing rate, subsequent revision surgeries and implant-related complications. Methods We conducted a retrospective chart review of patients with aseptic femoral subtrochanteric nonunions after failed intramedullary nailing. Nonunion treatment consisted of nail removal, debridement of the nonunion, and restoration of the neck shaft angle (CCD), followed by DCS plating. Supplemental bone grafting was performed in all atrophic nonunions. All patients were followed for at least six months after DCS plating. Results Between 2002 and 2017, we identified 40 patients with a mean age of 65.4 years (range 34–91 years) who met the inclusion criteria. At a mean follow-up period of 26.3 months (range 6–173), 37 of the 40 (92.5%) nonunions healed successfully (secondary procedures included). The mean healing time of the 37 patients was 11.63 months (± 12.4 months). A total of 13 of the 40 (32.5%) patients needed a secondary revision surgery; one patient had a persistent nonunion, nine patients had persistent nonunions leading to hardware failure, two patients had deep infections requiring revision surgery, and one patient had a peri-implant fracture due to low-energy trauma four days after the index surgery. Conclusions The results indicate that revision surgery of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screws is a reliable treatment option overall. However, secondary revision surgery may be indicated before final healing of the nonunion. |
topic |
Subtrochanteric nonunion Pseudarthrosis DCS Dynamic condylar screw Intramedullary nailing Hardware failure |
url |
http://link.springer.com/article/10.1186/s12891-018-2372-4 |
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