title: The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut.
abstract: OBJECTIVE
  Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing.
  
  
  METHODS
  We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months.
  
  
  RESULTS
  The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG.
  
  
  CONCLUSIONS
  We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.
authors.affiliation: U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rollo
authors.affiliation: U.O.C. Orthopedics and Traumatology, Hospital Miulli, Acqua Viva delle Fonti, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Tartaglia
authors.affiliation: U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Falzarano
authors.affiliation: U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pichierri
authors.affiliation: U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Stasi
authors.affiliation: U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Medici
authors.affiliation: U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy. drlordmec@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Meccariello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation; D004868:Equipment Failure; D005260:Female; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D012086:Reoperation; D011795:Surveys and Questionnaires
keywords: Allograft bone strut; Blade plate; Bone healing; Nail breakage; Non union; Subtrochanteric complications