75years old man with 4weeks old subtrochantric fracture. Suggest further management. H/o fracture at same site about 5years black and h/o infection due to which DHS wad removed



sir this seems to be an old atrophic non union u need to open it remove all fibrous material, cut the sclerotic margins on both side with saw till fresh bleeding edges and fix it with DHS along with iliac crest bone grafting. also explain patient about limb shortening which is already shortened. also time out infection by doing crp and are before hand. com forget to send intraop culture and sensitivity sample

ORIF WITH with DHS with bone grafting

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this is, I have done 1 open the fracture and freshened the ends 2. open the cavity with reamer 3 Reduce the fracture as anatomical as possible 4 To fix available plate that should be wide proximally ( distal femoral . plate) is used 5 Bone grafting with good amount of graft from illrac Crest Why not PFN or DHS 1 Both are fix angle implant and neck shaft angle is already disturb. 2. Intra medullary implant may be unable to introduce due to deformity in bone as well as bone marrow

Proximally the length and number of screws appear inadequate. Would like to see the distal end of the plate on xray. I would keep my fingers crossed till the fracture unites.

I absolutely agree wid dr. Atul goyal. Trim d edges, remove the callus formed, open the im canal and go for DHS and a bone graft. BUT U NEED TO CONTROLL THE INFECTION BEFORE SURGERY OR ELSE THERE ARE VERY HIGH CHANCES OF FAILURE AGAIN. SO DO NOT HURRY FOR THE SX UNTIL THE INFECTION SUBSIDES.

thx sir

Old non united #, advised cleaning & debridement of old fibrosis, nailing with inter locking & bone grafting.

I'd prefer IM fixation...bone grafting to be decided on table...n go for distal locking with back hammering to reduce the frx gap...early dynamisation may be preferable in this case. a metabolic profile should also be done preop.

Nice work

Infective nonunion with osteoporosis. have to correct osteoporosis first, needs bone grafting and fixation with long pfn. send fracture ends for culture and sensitivity.

If it's all healed and no signs of infection at present u can still opt for closed nailing but use an antibiotic coated nail to be on safer side and u can consider injecting bone marrow aspirate at the fracture site

It needs compression so plate is better I think

This is a non Union of sub trochantric region. Best fixed with open reduction and pfn followed by bone grafting after freshening the edges of the fracture if there are no signs of active infection now

IM nailing with interlocking /PFN, & bone grafting.

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