Nonunion of Fractures of the Subtrochanteric Region of the Femur

Nonunions of the subtrochanteric region of the femur are uncommon, however, they are difficult to treat. The massive compressive and tensile forces in this anatomic region, and the often malaligned proximal fragment make salvage of nonunion challenging. The presence of hardware, often broken, and bony defects in the femoral head from prior fixation attempts can compromise stable fixation. Various treatment strategies can be effective, however, all share common principles: restoration of the neck-shaft angle-avoiding varus, obtaining stable fixation of the proximal fragment, and obtaining good apposition of viable bony surfaces. Both intramedullary and plating techniques can be effective, and they are typically chosen based on prior failed fixation strategies, bony defects, and, importantly, the length of the remaining proximal segment. Data regarding salvage have generally been favorable, however, complication rates remain concerning.