Subtrochanteric nonunions may involve considerable shortening. A convincing method of concomitantly treating both combined
disorders has not been reported. Twenty-three consecutive patients with these combined disorders were treated by femoral condylar
skeletal traction, one-stage lengthening to 4 cm maximum, static locked nail stabilization, and corticocancellous bone grafting.
Indications for this technique included subtrochanteric aseptic nonunions, patient younger than 60 years, and 2.0 to 5.0 cm
shortening. Postoperatively, protected weightbearing ambulation was encouraged as early as possible. Twenty-one patients were
followed for a minimum of 1.2 years (mean, 3.2 years; range, 1.2–6.7 years). All nonunions healed with a union rate of 100%
(21 of 21) and a median union period of 4.0 months (range, 3.5–11 months). One nonunion healed at 11 months despite nail breakage.
In all patients, hip function improved from unsatisfactory grades preoperatively to satisfactory grades at latest followup.
Knee function grade remained satisfactory throughout the treatment course in all patients. Although no surgical technique
has clearly proven superior in treating subtrochanteric nonunions associated with considerable shortening, the described approach
may be the optimal treatment alternative. Protected weightbearing to reduce nail stress throughout the treatment course improves
the success rate.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
The author certifies that he or she has no commercial association (eg, consultancies, stock ownership, equity interest, patient/licensing
arrangement, etc) that might pose a conflict of interest in connection with the submitted article.
The author certifies that his or her institution either has waived or does not require approval for the human protocol for
his investigation and that all investigations were conducted in conformity with ethical principles of research.