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

Figure 4

(a) Atypical right subtrochanteric femur fracture created in a 68-year-old male with 8-year history of bisphosphonate use. (b) He underwent open reduction internal fixation with a locked piriformis reconstruction nail within 24 hours of injury. Note anatomic alignment immediately postoperatively. (c) At 8 weeks postoperatively, he had increased pain in his hip and felt a pop. New radiographs reveal hardware failure with nail fracture and varus collapse. (d) Given his adequate proximal femoral bone stock, he underwent revision open reduction internal fixation with removal of hardware, locked cephalomedullary nailing, and augmentative plating with autologous bone grafting of the nonunion site. (e) At 6 months postoperatively, he has radiographic signs of union and is pain-free and returned to all previous activities.

(a)

(b)

(c)

(d)

(e)