A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

Neetin P. Mahajan, Pranay Kondewar, Lalkar Gadod, Amey Sadar, Shubham Atal


Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site usingĀ  bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.


Subtrochanteric femur fracture, Non-union, Exchange nailing, Mis a nail technique, Bone grafting, Femur interlock nail

Full Text:



Joglekar SB, Lindvall EM, Martirosian A. Contemporary management of subtrochanteric fractures. Orthop Clin North Am. 2015;46(1):21-35.

Tomas J, Teixidor J, Batalla L, Pacha D, Cortina J. Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail. J Orthop Trauma. 2013;27(7):157-60.

Gdoutos EE, Raftopoulos DD, Baril JD. A critical review of the biomechanical stress analysis of the human femur. Biomaterials. 1982;3(1):2-8.

Park J, Yang KH. Correction of malalignment in proximal femoral nailing--Reduction technique of displaced proximal fragment. Injury. 2010;41(6):634-8.

Kulkarni SS, Moran CG. Results of dynamic condylar screw for subtrochanteric fractures. Injury. 2003;34(2):117-22.

Parker MJ, Dutta BK, Sivaji C, Pryor GA. Subtrochanteric fractures of the femur. Injury. 1997;28(2):91-5.

Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop Relat Res. 1992;(283):231-6.

Suckel AA, Dietz K, Wuelker N, Helwig P. Evaluation of complications of three different types of proximal extra-articular femur fractures: differences in complications, age, sex and surviving rates. Int Orthop. 2007;31(5):689-95.

Brighton B, Bhandari M, Tornetta P, Felson DT. Hierarchy of evidence: from case reports to randomized controlled trials. Clin Orthop Relat Res. 2003;413:19-24.

Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma. 2010;24(2):89-94.

Kang SH, Han SK, Kim YS, Kim MJ. Treatment of subtrochanteric nonunion of the femur: whether to leave or to exchange the previous hardware. Acta Orthop Traumatol Turc. 2013;47(2):91-5.

Claes L. Mechanobiologie der frakturheilung teil 2. Semantic scholar. 2017;120:23-31.

Calori GM, Giannoudis PV. Enhancement of fracture healing with the diamond concept: the role of the biological chamber. Injury. 2011;42(11):1191-3.

Tzioupis C, Panteliadis P, Gamie Z, Tsiridis E. Revision of a nonunited subtrochanteric femoral fracture around a failed intramedullary nail with the use of RIA products, BMP-7 and hydroxyapatite: a case report. J Med Case Rep. 2011;5:87.