ArticleArchives of orthopaedic and trauma surgery2019
Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures.
Article in Archives of orthopaedic and trauma surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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Who cites it
41 citing papers in PubMed, 68 citations in OpenAlex.
- What is the rate and degree of deformity in femoral diaphyseal nonunion? A CT-based retrospective cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Plate-tensioned reconstruction nail for proximal femur diaphyseal nonunion.OTA international : the open access journal of orthopaedic trauma · 2026Article
- Analysis of Factors Affecting the Union of Closed Subtrochanteric Femur Fractures treated by Cephalomedullary Nailing.Malaysian orthopaedic journal · 2026Article
- An integrated clinical and imaging model for predicting post-traumatic nonunion.Frontiers in medicine · 2026Article
- Does Cephalomedullary Nail Design Influence Risk of Varus Collapse in Subtrochanteric Femur Fractures?Orthopedic reviews · 2026Article
- Article
- Reply to the Letter to the Editor: What Factors Are Associated With Implant Revision in the Treatment of Pathologic Subtrochanteric Femur Fractures?Clinical orthopaedics and related research · 2025Article
- Risk factors for implant failure of PFNA-II in the treatment of intertrochanteric fractures (AO/OTA 31 A1 and A2).BMC musculoskeletal disorders · 2025Article
- Exploring Appropriate Positioning of the Spiral Blade in Treatment of Subtrochanteric Fractures of the Femur Using Proximal Femoral Nail Antirotation.Orthopaedic surgery · 2025Article
- Comparative efficacy of Nice knot versus lag screw in augmenting locking plate fixation for comminuted clavicular fractures: a retrospective cohort study.BMC musculoskeletal disorders · 2025Article
- Does Hip Abduction during Intramedullary Nail Fixation Help Correct Residual Varus Alignment in Subtrochanteric Fractures? A Retrospective Cohort Study.Clinics in orthopedic surgery · 2025Article
- Neck shaft angle deviation in patients undergoing femoral limb lengthening, a retrospective study.International orthopaedics · 2025Article
- Use of medialized trochanteric-entry intramedullary nail to improve alignment in proximal femur nonunions.International orthopaedics · 2025Article
- Improving agreement in assessing subtrochanteric fracture healing among orthopedic surgeons using the Radiographic Union Score for Hip (RUSH).BMC musculoskeletal disorders · 2024Article
- [Nonunions after intertrochanteric and subtrochanteric femoral fractures].Unfallchirurgie (Heidelberg, Germany) · 2024Article
- The effect of valgus reduction on resistant subtrochanteric femoral non-unions: a single-centre report of twenty six cases.International orthopaedics · 2024Article
- Subtrochanteric nonunion after intramedullary nailing due to pathological fracture: proximal femoral replacement as a salvage approach.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Varus mal-alignment and residual displacement are associated with delayed union in subtrochanteric femur fracture- A retrospective observational study.Journal of orthopaedics · 2023Article
- The role of an augmentative plating in the management of femoral subtrochanteric nonunion.Archives of orthopaedic and trauma surgery · 2023Article
- Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?BMC musculoskeletal disorders · 2023Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures. MATERIALS AND
methodsSeventy-four patients who sustained a subtrochanteric fracture and were treated by femoral intramedullary nailing at a single level 1 trauma centre within a 6-year period were included in this study. A total of 15 patient-related, fracture-related, surgery-related, mechanical and biological parameters were analysed as potential risk factors for nonunion. Furthermore, the accuracy of each of these parameters to predict nonunion was calculated.
resultsNonunion occurred in 17 of 74 patients (23.0%). Of the 15 potential risk factors analysed, only 3 were found to have a significant effect on the nonunion rate (p < 0.05): postoperative varus malalignment, postoperative lack of medial cortical support and autodynamisation of the nail within the first 12 weeks post-surgery. Accuracy of each of these 3 parameters to predict nonunion was > 0.70. Furthermore, the nonunion rate significantly increased with the number of risk factors (no risk factor: 2.9%, one risk factor: 23.8%, two risk factors: 52.9%, and three risk factors: 100% [Chi-square test, p = 0.001)].
conclusionsOur study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.
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