Managing bone deficiency and nonunions of the proximal femur.
Revision surgery of the proximal femur with bone loss secondary to failed cephalomedullary nails is problematic and becoming more prevalent as their use grows. This article presents a technique of deformity correction, bone graft techniques that reconstitute residual defects, and definitive fixation using load-sharing devices that provide immediate stability for bone healing and early rehabilitation. Preoperative planning and the potential advantages and disadvantages of newer fixed-angled plates versus established implants are discussed. With proper planning, surgical execution with proved techniques, augmented by the addition of newer graft harvesting techniques, anatomic restoration, and bone reconstitution with healing, has invariably been the result.
Perry
John J
JJ
Mammoth Orthopedics and Sports Medicine, PO Box 3834, Mammoth Lakes, CA 93546, USA. jperry1014@aol.com
Winter
Brent
B
Mast
Jeffrey W
JW
D000328:Adult; D001862:Bone Resorption / Q000517:prevention & control*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*