Case Reports
Nonunion of a Pertrochanteric Femur Fracture Due to a Low-Velocity Gunshot
Am J Orthop. 2011 January;40(1):E5-E9
Author and Disclosure Information
Brian J. Evanson, MD, Brian H. Mullis, MD, Jeffrey O. Anglen, MD, FACS
Dr. Evanson is Orthopaedic Resident, University of Toledo, Toledo, Ohio.
Dr. Mullis is Chief of Orthopaedic Trauma Services and Assistant Professor of Clinical Orthopaedics, and Dr. Anglen is Chairman and Professor of Orthopaedics, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
The treatment of nonunions often can be a complex and challenging venture. This case report details the treatment of a young patient’s pertrochanteric femoral nonunion due to a low-velocity gunshot. Fracture fixation and union were attempted with various implants, including a sliding hip screw, blade plate, and proximal femoral locking plate; however, all eventually failed. Successful union ultimately was obtained only after use of a cephalomedullary nail. There have been few reports in the literature on the failure of proximal femoral locking plates in the treatment of pertrochanteric femur fractures, though much has been published regarding the sliding hip screw and blade plate. Multiple options for use in nonunion surgery were used and discussed in this case, such as autogenous bone graft, bone morphogenic protein, and implantable bone stimulators.