Nonunion of subtrochanteric fractures: Comminution or malreduction

Objective: this study aimed to investigate the impact on nonunion of the extent of comminution and postoperative displacement in patients surgically treated for subtrochanteric fractures. methods: from 2008 to 2013,44 patients with subtrochanteric fractures underwent surgery and follow-up. retrospective data collection showed that it had 32 male and 12 female. their mean age was 45 years. the case distribution according to seinsheimer classification was as follows: iia,8; iib,5; iic,7; iiia,8; iiib,3; iv,9; and v,4. cephalomedullary nails were used in 28 cases; ordinary nails,in 9; and plates,in 7. after surgery,the fractures were evaluated for displacement on anteroposterior (ap) and lateral radiography. results: of the 44 patients,37 achieved union from primary surgery at a mean time of 8.4 months. five cases did not show union within the follow-up period. two cases of nail breakage were diagnosed as nonunion. among the non-union cases,two were seinsheimer classification iiia; 3,iv; and 2,v. displacement was observed on the lateral and a pradiographs of 4 cases,on only the lateral radiographs of two cases,and in neither radiograph of one case. the risk of non-union was approximately 15.4 and 24.2 times higher when displacement was observed on the ap (95% confidence interval [ci]: 1.33-176.82) and lateral images (95% ci: 1.76-335.67),respectively. conclusion: when displacement occurred after surgical treatment for subtrochanteric fractures,the risk of nonunion increased owing to the difficulty achieving stable fixation. © 2016,professional medical publications. all rights reserved.