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Management of Refractory Aseptic Subtrochanteric Non-union by Dual Plating

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Abstract

Background

Subtrochanteric fractures are challenging to treat because of their anatomical and biomechanical behaviours. Non-unions of this region become much more difficult to treat because of the previous surgical scar, fibrosis, mal-reduction, presence of an implant, compromised soft tissue, and osseous vascularity, bone-mass loss etc. The aim is to provide a stable mechanical environment by PF-LCP, augmented by LCP (dual plating) where biology can work uneventfully. Biology is re-initiated by decortication (shingling) and autologous cancellous bone graft.

Methods

Twelve cases of failed aseptic subtrochanteric non-union either with intact or broken implant were included in this study in a period of 3 years from August 2016 to July 2019. The interposing fibrous tissue resected in patients with mal-aligned fragments. The mechanical stabilization is achieved by orthogonal dual plating. PF-LCP on lateral and 4.5 mm LCP anteriorly, decortication, and cancellous graft applied before applying for the anterior plate. Patients were encouraged for a toe-touch walk with walking-frame from 3rd post-operative day. Functional outcomes were assessed using Parker Mobility Score (PMS).

Results

All fractures united in 7 ± 1.53 months. ROM at the knee remained unchanged but improved at the hip after revision surgery. Average PMS improved to 7.58 from pre-revision 1.75 validating the efficacy of this protocol.

Conclusion

Adequate stability by dual-plate construct and re-initiation of cellular and biochemical processes by decortication and cancellous bone-graft reunited ununited subtrochanteric fractures. This particular combination of plates and decortication has not been employed earlier as per our review of the literature.

Aim

To offer a new paradigm for the management of surgically failed subtrochanteric non-unions.

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Authors and Affiliations

  1. Department of Orthopaedics, Krishna Hospital and Trauma Centre, J 85 Patel Nagar I, Ghaziabad, Uttar Pradesh, 201001, India

    Krishna Kumar Mittal

  2. Krishna Hospital and Trauma Centre, Ghaziabad, India

    Apoorva Agarwal & Nishant Raj

Authors
  1. Krishna Kumar Mittal
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  2. Apoorva Agarwal
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  3. Nishant Raj
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Correspondence to Krishna Kumar Mittal.

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Conflict of interest

The authors hereby, declare that there is no conflict of interest in this study. This study is not sponsored/funded by any institution. All patients were admitted and operated by the authors only.

Ethical standard statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

All patients were operated upon after taking their informed consent. Nowhere in this study, identity/ethnicity/gender of patient is disclosed.

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Mittal, K.K., Agarwal, A. & Raj, N. Management of Refractory Aseptic Subtrochanteric Non-union by Dual Plating. JOIO 55, 636–645 (2021). https://doi.org/10.1007/s43465-020-00318-w

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  • DOI: https://doi.org/10.1007/s43465-020-00318-w

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