Bone Graft in Aseptic Subtrochanteric Nonunion

Study Overview
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Brief Summary
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This study aimed to compare the radiologic results between closed nailing without bone graft (BG) and open nailing with BG for subtrochanteric nonunion and to determine when open BG should be considered.

Detailed Description
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In this retrospective study, we investigated the patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. The cases with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up less than 1 year were excluded. We compared the demographic details and radiologic results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated.

Official Title
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Is Open Bone Graft Always Necessary When Treating Subtrochanteric Nonunion With a Reamed Intramedullary Nail?

Conditions
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Subtrochanteric Nonunion

Intervention / Treatment
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* Procedure: Revision surgery with / without open bone graft


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who underwent surgical intervention using intramedullary nailing for aseptic subtrochanteric nonunion Exclusion Criteria: The cases with infection, large bone defect, pathologic fracture, open fracture, previous and revision surgery using plate, and follow-up less than 1 year

Ages Eligible for Study
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Minimum Age: 32 Years
Maximum Age: 82 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Bone graft group<br>The bone graft group (n=19) who underwent open nailing with open bone graft for aseptic subtrochanteric nonunion | Procedure: Revision surgery with / without open bone graft<br>* Removal of previous implant and re-alignment and re-fixation using intramedullary nail with (bone graft group) / without (non bone graft group) open bone graft<br>|
| Non bone graft group<br>The non-BG group (n=18) who underwent closed reamed nailing without bone graft for aseptic subtrochanteric nonunion | Procedure: Revision surgery with / without open bone graft<br>* Removal of previous implant and re-alignment and re-fixation using intramedullary nail with (bone graft group) / without (non bone graft group) open bone graft<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| bony union | Union was defined as painless full weight bearing with the absence of fracture line or bridging callus across at least three cortices on the AP and lateral views. | The time when bone union was achieved after surgery | 
| risk factors for nonunion | Determining when open procedure with bone graft should be considered by analyzing risk factors for nonunion. | One year after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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subtrochanteric nonunion; intramedullary nail; bone graft