Outcome of revision surgery for bisphosphonate related subtrochanteric fracture non-union following failed intramedullary nailing.

Abstract

Bisphosphonates use is a recognised cause of atypical femur fractures. Intramedullary nailing is the first line of treatment for these fractures, but failure is a common problem due to altered biology, resulting in a non-union and a challenging problem. There is lack of evidence in the literature on revision surgery for the management of non-union after failed nailing in atypical femur fracture. We present our experience of treating this complex problem. A retrospective review of all consecutive cases of revision surgery for non-union of bisphosphonate related subtrochanteric fractures was undertaken. All procedures were performed between 2012 and 2017 by a single surgeon. Revision surgery included removal of failed metalwork, resection of non-union, bone grafting and double plating with a lateral DCS plate and anterior locking compression plate. Ten patients (9 females, 1 male) were included with a mean age of 71.5 years and mean BMI of 34 at the time of revision. All patients received previous Bisphosphonate treatment on average for 6.2 years. One patient was lost to follow up. Mean time for non-weight bearing (NWB) mobilization was 7 months and mean time for union was 14 months. Fracture healing can be achieved with bone grafting and compression plating in all patients. However, a prolonged time to achieve union and a long follow-up duration should be expected.