title: The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients.
abstract: BACKGROUND
  Intertrochanteric femoral fractures are common, but the nonunion of intertrochanteric fractures is not. The purpose of this study was to divide intertrochanteric fracture nonunion into different types and give corresponding treatment strategies.
  
  
  METHODS
  We retrospectively evaluated 23 patients with intertrochanteric fracture nonunion. The patients were divided into five groups and each group was treated with a different strategy. All patients had staged clinical and radiographic follow-ups and the mean follow-up was 16.0±4.6months.
  
  
  RESULTS
  Except for the patients treated with total hip arthroplasty, all patients achieved fracture union. The mean union time was 4.7±1.2months. The Harris hip function score differed significantly from preoperative (28.9±6.8) to postoperative (83.8±6.3; p<0.05). For the three patients who were classified as type III, the femoral neck shaft angle was corrected to a significant degree, from 97.3±6.4 to 127.3±2.5 (p<0.05). For the four patients who were classified as type V, the mean time from debridement to re-internal fixation was 3.7±1.5months.
  
  
  CONCLUSIONS
  There are several factors associated with the failure of intertrochanteric fracture treatments. We need to analyze the causes of fracture treatment failure carefully. Based on our five classifications and corresponding treatment strategies, the radiographic and functional treatment outcomes were satisfactory. Future larger comparative studies are needed to confirm our results.
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: xuedeting@163.com.
authors.forename: Deting
authors.initials: D
authors.lastname: Xue
authors.affiliation: Department of Orthopaedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, 311800, Zhejiang, China. Electronic address: yujiawei1990@163.com.
authors.forename: Jiawei
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: zhengqiang1967@homtmail.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zheng
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: fenggang123@163.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Feng
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: liwenxu234@126.com.
authors.forename: Weixu
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: panzhijun001@163.com.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Pan
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: wangjian1@hotmail.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China. Electronic address: lihanghz001@163.com.
authors.forename: Hang
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001863:Bone Screws; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Intertrochanteric fractures nonunion; Re-internal fixation; Revision; THA; Treatment strategy