Plate - nail construct using a Realign, Compress and Nail (ReCoN) strategy without supplemental bone grafting for subtrochanteric nonunions.

Abstract

To assess the healing rate and improvements in hip and lower limb function using a tensioned plate - nail construct without bone grafting in the treatment of subtrochanteric nonunions. Two urban trauma centers in India. Retrospective cohort studyPatient selection criteria. 2023 operated for subtrochanteric fracture nonunions (AO/OTA 31 A3.1,2 and 3) using a tensioned plate - nail construct without bone grafting. The primary outcome measure was healing of the nonunion after repair using the plate - nail construct without bone grafting. Secondary outcome measures were improvements in neck - shaft angle (NSA), limb length discrepancy (LLD), Harris hip score (HHS), lower extremity functional scale (LEFS) post-surgery, and the need for further surgical procedures. The study cohort included 26 males and 20 females (46 patients) with a mean age of 60 years (range 29 - 82 years). The nonunion healed in 44 (96%) patients after fixation with the plate - nail construct. One patient needed another revision surgery to achieve healing. Significant improvements were seen in NSA (127° ± 4.5° vs 111° ± 7°, P < 0.001) and LLD (0.5 ± 0.4 cm vs 1.5 ± 0.8 cm, P = 0.02) post-surgery. Functional assessment in 39 patients at a mean follow up of 40 ± 20 months showed significant improvements in HHS (85 ± 8 vs 36 ± 8 points, P < 0.001) and LEFS (66 ± 7 vs 22 ± 6 points, P < 0.001). Consistent healing with significant improvements in limb length, hip and lower limb function were achieved using the plate - nail assisted technique of realignment and nonunion compression without supplemental bone grafting in the treatment of subtrochanteric nonunions. IV.