Obey Mitchel R, Achor Timothy S, Warner Stephen J
Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Washington University in St. Louis, 660 S. Euclid Campus, Box 8233, St. Louis, MO, 63110, USA.
Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
Int Orthop. 2025 Jan;49(1):75-82. doi: 10.1007/s00264-024-06357-4. Epub 2024 Oct 31.
Proximal femur shaft nonunion is a challenging problem, often occurring after malreduction that results in postoperative malalignment and decreased healing potential. Correction of malalignment is critical to achieving osseous union. Here we present a novel technique for treating proximal femur nonunions with varus malalignment using an intramedullary nail inserted through a medialized trochanteric entry point.
Patients who underwent a proximal femur shaft (subtrochanteric or proximal third shaft) nonunion operation at a single level 1 academic referral centre by two attending surgeons between 1/1/2014 and 1/1/2022 were identified. Radiographic imaging was reviewed to determine initial fracture classification and calculation of coronal plane alignment (CPA), which was measured on preoperative, immediate postoperative, and final follow-up radiographs. Postoperative complications, reoperations, infections, and osseous union were also collected.
Twenty-one patients with a mean age of 49.9 years (66% male) were identified. Mean preoperative CPA was 125.6 degrees, immediate postoperative mean CPA was 132.6 degrees, and mean final follow-up CPA was 131.5 degrees. Mean change in CPA from immediate postoperative films to final follow-up was a decrease of 0.4 degrees. 17 patients had follow up for a minimum of 12 months or until osseous union, and all achieved union without any major complications.
Exchange nailing with an antegrade trochanteric entry nail through a medialized trochanteric starting point is a safe and effective technique in the treatment of proximal femur nonunions. This technique results in improved postoperative alignment that is sustained throughout the postoperative course, and may lead to increased rates of osseous union.
股骨近端骨干骨不连是一个具有挑战性的问题，常发生于复位不良后，导致术后对线不良及愈合潜力降低。纠正对线不良对于实现骨愈合至关重要。在此，我们介绍一种通过经内侧大转子入点插入髓内钉治疗伴有内翻畸形的股骨近端骨不连的新技术。
确定2014年1月1日至2022年1月1日期间在一家一级学术转诊中心由两位主治医生进行股骨近端骨干（转子下或近端三分之一骨干）单节段骨不连手术的患者。回顾影像学检查以确定初始骨折分类并计算冠状面力线（CPA），在术前、术后即刻及最终随访X线片上进行测量。还收集术后并发症、再次手术、感染及骨愈合情况。
共确定21例患者，平均年龄49.9岁（66%为男性）。术前平均CPA为125.6度，术后即刻平均CPA为132.6度，最终随访平均CPA为131.5度。从术后即刻X线片到最终随访，CPA的平均变化为降低0.4度。17例患者至少随访12个月或直至骨愈合，所有患者均实现愈合且无任何重大并发症。
经内侧大转子起始点逆行插入转子入点髓内钉进行交锁髓内钉更换是治疗股骨近端骨不连的一种安全有效的技术。该技术可改善术后对线，且在整个术后过程中得以维持，并可能提高骨愈合率。
