前内侧强化固定治疗股骨转子下骨折内固定术后骨不连OA

Objective To investigate the clinical efficacy of anteromedial augmentation fixation in treating nonunion after internal fixation of subtrochanteric femoral fractures.Methods A retrospective analysis was conducted on the clinical data of 8 patients with nonunion after internal fixation of subtrochanteric femoral fractures,who were admitted between November 2018 and June 2022.The cohort included 3 cases on the left side and 5 on the right.The types of initial internal fixation were as follows:4 cases with Gamma 3 intramedul-lary nails,2 with locking plates(including 1 case that underwent Gamma 3 fixation after refracture following plate removal),1 with reconstruction nail combined with lateral reinforcement plate,and 1 with proximal femo-ral nail antirotation(PFNA)device.All patients were treated with anteromedial iliac bone grafting combined with tension band wiring at the fracture site and/or plate-screw augmentation for reinforcement,with retention or exchange of the intramedullary nail for refixation.Results Among the 8 patients,3 underwent conversion to Gamma 3 intramedullary nail with adjunctive anterior tension band wiring.The original Gamma 3 intramedullary nail was retained in the remaining 5 patients,among whom 3 received augmentation with additional plate,and 2 underwent augmentation with both plate and tension band wiring.All patients were followed up for 12 to 36 months,with a mean of(21.88±9.05)months.Bone union was achieved in all patients,with a healing time ranging from20 to32 weeks and a mean of(24.25±4.06)weeks.One case of infection around the tension band wiring occurred 2 years postoperatively.At the last follow-up,the Harris hip score was rated as excellent in 7 cases and good in 1 case.Conclusion Anteromedial augmentation fixation combined with bone grafting for subtrochanteric nonunion is associated with minimal invasiveness,reliable stability,and satisfactory bone union.