title: Reversed distal femoral locking plate for failed proximal femoral nail with non-union of proximal femoral fractures.
abstract: Failure of proximal femoral fracture managed by proximal femoral nail (PFN) leads to a very difficult situation to handle with conventional techniques, and reversed distal femoral locking compression plate (DF-LCP) is of great benefit in these selective cases.
  
  
  
  Twelve patients with ununited proximal femoral fractures including subtrochanteric fractures with a failed PFN implant were included in the study. All patients with periprosthetic fractures and fractures treated by implants other than PFN were excluded from this study.
  
  
  
  All fractures went into union in an average time of nine months and 15 days with no implant failures. The mean time of re-osteosynthesis after the primary index surgery of PFN was one year eight months. Mean surgical time of re-osteosynthesis was 110 minutes, and average blood loss during surgery was 550 ml.
  
  
  
  The PFM is one of the most commonly used implant for unstable proximal femur fractures. The use of PFN is technically demanding and is associated with high failure rates. Although dynamic compression screw (DCS), proximal femoral locking plate (PF-LCP) and other implants can be used in these failed situations, they are associated with a high complication rate. The reversed DF-LCP is a rescue implant for these complex situations. Apart from anatomical and biomechanical advantages, there are several other clinical benefits of using DF-LCP.
  
  
  
  We conclude that DF-LCP is a potential and safe implant of choice for the management of nonunion associated with failed PFN. It may be considered an implant of choice as rescue from such a complex situation. It offers several anatomical, biomechanical and clinical advantages over other available conventional implants.
authors.affiliation: Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi, India, 110076.
authors.forename: Raju
authors.initials: R
authors.lastname: Vaishya
authors.affiliation: Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi, India, 110076. amitorthopgi@yahoo.co.in.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Agarwal
authors.affiliation: Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi, India, 110076.
authors.forename: Nishint
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi, India, 110076.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
mesh_terms: D001858:Bone Nails; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D061646:Operative Time; D057068:Periprosthetic Fractures / Q000601:surgery*
keywords: Distal femoral locking plate; Nonunion fracture; Proximal femur; Re-osteosynthesis