Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

Figure 2

(a) A 85-year-old active female sustained a fall from standing height onto her right hip resulting in an unstable displaced intertrochanteric femur fracture. (b) She underwent locked cephalomedullary nailing within 24 hours of the injury at an outside institution. The neck-shaft angle measures 119 degrees with a 130-degree implant. Note the cranial endpoint for the compression screw. (c) She was referred to an arthroplasty specialist 7 months later with catastrophic failure, screw cutout, and associated acetabular defect. (d) After a long discussion with the patient and her desire for pain relief and ability to ambulate, the decision was made for removal of hardware with femoral head resection and obtainment of cultures. (e) Two days later, cultures were negative for infection, and she was brought back to the operating room for total hip arthroplasty implantation with acetabular augment to correct defect created by the compression screw cutout. A long diaphyseal-fitting stem was used given the poor proximal bone stock, and a cable was placed to support the lateral cortex from lag screw stress riser. The patient is ambulating without pain or assist device 10 months postoperatively.

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