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Nonunions of the Proximal Femur

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Abstract

Nonunions of the proximal femur may be severely disabling when they occur in active individuals [1, 2], although elderly people may live reasonably normal lives with nonunions of the upper extremity long bones (e.g., clavicle, humerus, and forearm). Femoral nonunions, however, are more frequently painful and may preclude weightbearing on the affected extremity. If, however, pain is minimal or nonexistent and occurring within a nonambulatory individual, nonoperative management is the treatment of choice.

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References

  1. Leung PC, Shen WY. Fracture of the femoral neck in younger adults. Clin Orthop Relat Res. 1993;295:156–60.

    Google Scholar 

  2. Scheck M. The significance of posterior comminution in femoral neck fractures. Clin Orthop Relat Res. 1980;152:138–42.

    Google Scholar 

  3. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23(2):80–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hou MH, Hang YS, Liu TK. Ununited femoral neck fractures by open reduction and vascularized iliac bone graft. Clin Orthop Relat Res. 1993;294:176–80.

    Google Scholar 

  5. Nair N, Patro DK, et al. Role of muscle pedicle bone graft as an adjunct to open reduction and internal fixation in the management of neglected and ununited femoral neck fracture in young adults: a prospective study of 17 cases. Eur J Orthop Surg Traumatol. 2014;24(7):1185–91.

    Article  PubMed  Google Scholar 

  6. Waddel JP. Subtrochanteric fractures of the femur: a review of 130 patients. J Trauma. 1979;19:585–92.

    Google Scholar 

  7. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg. 1971;53B:183–97.

    Google Scholar 

  8. Harding AF, Cook SD, Thomas KA, Collins CL, Haddad RJ Jr, Milicic M. A clinical and metallurgical analysis of retrieved Jewett and Richards hip plate devices. Clin Orthop Relat Res. 1985;195:261–9.

    Google Scholar 

  9. Ward FO. Human anatomy. London: Renshaw; 1838.

    Google Scholar 

  10. Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop. 1980;152:10–6.

    Google Scholar 

  11. Swiontkowski MF, Ganz R, Schlegel U, Perren SM. Laser Doppler flowmetry for clinical evaluation of femoral head osteonecrosis. Preliminary experience. Clin Orthop Relat Res. 1987;218:181–5.

    Google Scholar 

  12. Trueta J, Harrison MHM. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg. 1953;35B:442–61.

    Google Scholar 

  13. Cathcart RF. The shape of the femoral head and preliminary results of clinical use of a non-spherical hip prosthesis. J Bone Joint Surg. 1971;53A:397.

    Google Scholar 

  14. Mathews V, Cabanela ME. Femoral neck nonunion treatment. Clin Orthop Relat Res. 2004;419:57–64.

    Article  Google Scholar 

  15. Raaymakers EL, Marti RK. Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Ind J Orthop. 2008;42(1):13–21.

    Article  Google Scholar 

  16. Dhammi I, Jain A, Singh A, Rehan-Ul-Haq, Mishra P, Jain S. Primary nonunion of intertrochanteric fractures of femur: an analysis of results of valgization and bone grafting. Ind J Orthop. 2011;45(6):514–9.

    Article  Google Scholar 

  17. Elgafy H, Ebraheim F, Nabil A, Gregory H. Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma-Inj Infect Crit Care. 2011;70(1):169–73.

    Article  Google Scholar 

  18. Rosen H. Treatment of nonunions: general principles. In: Chapman MW, editor. Operative orthopaedics. 2nd ed. Philadelphia: Lippincott; 1993.

    Google Scholar 

  19. Srivastav S, Mittal V, Agarwal S. Total hip arthroplasty following failed fixation of proximal hip fractures. Ind J Orthop. 2008;42(3):279–86.

    Article  Google Scholar 

  20. Skinner PW, Powles D. Compression screw fixation for displaced subcapital fracture of the femur: success or failure. J Bone Joint Surg. 1986;68B:78–82.

    Google Scholar 

  21. Svenningsen S, Benum P, Nesse O, Furset O. Internal fixation of femoral neck fractures: compression screw compared with nail-plate fixation. Acta Orthop Scand. 1984;55:423–9.

    Article  PubMed  CAS  Google Scholar 

  22. Brinker MR, Hanus BD, Sen M, O’Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am. 2013;95(24):2170–6.

    Article  PubMed  Google Scholar 

  23. Harty M. The calcar femorale and the femoral neck. J Bone Joint Surg. 1957;39A:625–30.

    Article  Google Scholar 

  24. Haidukewych GJ, Berry DJ. Salvage of failed internal fixation of intertrochanteric hip fractures. Clin Orthop Relat Res. 2003;412:184–8.

    Article  Google Scholar 

  25. Franzen H, Nillsson LT, Stromqvist B, Johnsson R, Herrlin K. Secondary total hip replacement after fractures of the femoral neck. J Bone Joint Surg. 1990;72-B:784–7.

    Google Scholar 

  26. Pho RW, Vajara R, Satku K. Free vascularized transplants in problematic nonunions of fractures. J Trauma. 1983;23:341–9.

    Article  PubMed  CAS  Google Scholar 

  27. Yang J-J, Lin L-C, Chao K-H, Chuang S-Y, Chia-Chun W, Yeh T-T, Lian Y-T. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg. 2013;95(1):61–9.

    Article  PubMed  Google Scholar 

  28. Mariani ME, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation. Clin Orthop Relat Res. 1987;218:81–9.

    Google Scholar 

  29. Schatzker J, Ha’eri GB, Chapman M. Methyl methacrylate as an adjunct in the internal fixation of intertrochanteric fractures of the femur. J Trauma. 1978;18:732–5.

    Article  PubMed  CAS  Google Scholar 

  30. Meyer S, Weiland AJ, Willenegger H. The treatment of infected non-union of fractures of long bones. J Bone Joint Surg. 1975;57-A:836–42.

    Article  Google Scholar 

  31. Charnley GJ, Ward AJ. Reconstruction femoral nailing for nonunion of subtrochanteric fracture. Int Orthop. 1996;20:55–7.

    Article  PubMed  CAS  Google Scholar 

  32. Parker MJ, Khan RK, Crawford PGA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly: a randomised trial of 455 patients. J Bone Joint Surg Br. 2002;84-B:1150–5.

    Article  Google Scholar 

  33. Lifeso R, Young D. The neglected hip fracture. J Orthop Trauma. 1990;4:287–92.

    Article  PubMed  CAS  Google Scholar 

  34. Massie WK. Treatment of femoral neck fractures emphasizing long term follow-up observations on aseptic necrosis. Clin Orthop Relat Res. 1973;92:16–62.

    Article  Google Scholar 

  35. Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009;23:471–8.

    Article  PubMed  Google Scholar 

  36. Banks HH. Nonunion in fractures of the femoral neck. Orthop Clin N Am. 1974;5:865–85.

    CAS  Google Scholar 

  37. Christy J, Howie C, Armoir P. Fixation of displaced femoral neck fractures: compression screw fixation vs. double divergent pins. J Bone Joint Surg. 1988;70B:199–201.

    Google Scholar 

  38. Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007;335:1251.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002;399:110–8.

    Article  Google Scholar 

  40. Stromqvist B, Hansson L, Nilsson L, Thorngren K. Hook pin fixation in femoral neck fractures: 2 year follow up study on 300 cases. Clin Orthop. 1987;218:58–62.

    Google Scholar 

  41. Steinberg ME. Diagnostic imaging and the role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Tech Orthop. 2001;16:6–15.

    Article  Google Scholar 

  42. Sims SH. Subtrochanteric femur fractures. Orthop Clin N Am. 2002;33(1):113–26. viii

    Article  Google Scholar 

  43. Sarathy MP, Madhavan P, Ravichandran KM. Nonunion of intertrochanteric fractures of the femur. J Bone Joint Surg. 1994;77-B:90–2.

    Google Scholar 

  44. Karaeminogullari O. Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery. Adv Ther. 2004;21(5):335–42.

    Article  PubMed  Google Scholar 

  45. Bartonícek J, Skyla-Rosenbaum J, Dousa P. Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma. 2003;17:606–12.

    Article  PubMed  Google Scholar 

  46. Mabry TM. Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg. 2004;86(10):2263–7.

    Article  PubMed  Google Scholar 

  47. Bogoch E, Ouellette G, Hastings D. Failure of internal fixation of displaced femoral neck fractures in rheumatoid patients. J Bone Joint Surg. 1991;73-B:7–10.

    Google Scholar 

  48. Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95° screw-plate. J Bone Joint Surg. 2002;84:371–81.

    Article  Google Scholar 

  49. Schottel PC, O’Connor DP, Brinker MR. Time trade-off as a measure of health-related quality of life: long bone nonunions have a devastating impact. J Bone Joint Surg Am. 2015;97(17):1406–10.

    Article  PubMed  Google Scholar 

  50. Williams PL, Warwick R, Dyson M, Bannister LH, editors. Gray’s anatomy, vol. 37. New York: Churchill Livingstone; 1989. p. 267–635.

    Google Scholar 

  51. Haidukewych GJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg. 2003;85-A(5):899–904.

    Article  PubMed  Google Scholar 

  52. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg. 1978;60-A:300–6.

    Article  Google Scholar 

  53. Velasco RU, Comfort TH. Analysis of treatment problems in subtrochanteric fractures of the femur. J Trauma. 1978;18:513–23.

    Article  PubMed  CAS  Google Scholar 

  54. Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of femoral neck nonunions with a sliding compression screw: comparison with and without subtrochanteric valgus osteotomy. J Trauma. 1999;46:312–7.

    Article  PubMed  CAS  Google Scholar 

  55. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg. 1957;39B:358–93.

    Google Scholar 

  56. Anglen JO. Intertrochanteric osteotomy for failed internal fixation of femoral neck fracture. Clin Orthop Relat Res. 1997;341:175–82.

    Article  Google Scholar 

  57. Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. J Bone Joint Surg. 1997;79-B:738–41.

    Article  Google Scholar 

  58. Howe WW, Lacey T, Schwartz RP. A study of the gross anatomy of the arteries supplying the proximal portion of the femur and acetabulum. J Bone Joint Surg. 1950;32A:856–66.

    Article  Google Scholar 

  59. Parker MJ. Prediction of fracture union after internal fixation of intracapsular femoral neck fractures. Int J Care Inj. 1994;25:S-B3–6.

    Article  Google Scholar 

  60. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg. 1979;61-A:216–21.

    Article  Google Scholar 

  61. Meyers MH. The role of posterior bone grafts (muscle pedicle) in femoral neck fracture. Clin Orthop. 1980;152:143–14.

    Google Scholar 

  62. Nagi ON, Dhillon MS, Goni VG. Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg. 1998;80-B:798–804.

    Article  Google Scholar 

  63. Bergman GD, Winquist RA, Mayo KA, Hansen ST Jr. Subtrochanteric fracture of the femur. J Bone Joint Surg. 1987;69-A:1032–9.

    Article  Google Scholar 

  64. Frangakis EK. Intracapsular fractures of the neck of the femur: factors influencing non-union and ischemic necrosis. J Bone Joint Surg. 1966;48B:17–30.

    Google Scholar 

  65. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. J Bone Joint Surg. 1994;76-A:15–25.

    Article  Google Scholar 

  66. Haidukewych GJ, Berry DJ. Nonunion of fractures of the sub trochanteric region of the femur. Clin Orthop Relat Res. 2004;419:185–8.

    Article  Google Scholar 

  67. Griffin JB. The calcar femorale redefined. Clin Orthop. 1982;164:211–4.

    Google Scholar 

  68. Bhuyan BK. Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture. Ind J Orthop. 2012;46(4):439–46.

    Article  Google Scholar 

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Correspondence to Kenneth A. Egol .

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Egol, K.A., Gales, J. (2018). Nonunions of the Proximal Femur. In: Egol, K., Leucht, P. (eds) Proximal Femur Fractures. Springer, Cham. https://doi.org/10.1007/978-3-319-64904-7_10

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  • DOI: https://doi.org/10.1007/978-3-319-64904-7_10

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