Subtrochanteric fractures are known for intraoperative difficulties with reduction and high rates of postoperative complications including non-union. Although achievement of bone support and maintenance of good alignment are key features of treatment, high-energy trauma sometimes causes a comminuted fracture. Further, infected non-union causes bone loss after achieving eradication of the infection with bone debridement . The initial comminuted fracture and bone debridement sometimes cause bone loss on the medial side. the surgical strategy for treatment of infected non-union of subtrochanteric fractures with medial-side bone loss is discussed here.
A 19-year-old man had left a subtrochanteric fracture in a traffic accident. According to the AO classification, the diagnosis was 32C3i . Initial surgery was performed with a short proximal femoral nail. One month after the operation, he developed methicillin-resistant Staphylococcus aureus (MRSA)-infected non-union of the subtrochanteric fracture. Two debridement procedures and application of vancomycin-impregnated cement beads eradicated the infection 7 months after the initial surgery. However, medial bony support loss was present. Hence, according to the modified Dimon method, open reduction and internal fixation (ORIF) with en bloc iliac bone transportation was performed in the lateral decubitus position. A compression hip screw because abundant cancellous bone was positioned at the superior part of the femoral head.
Nine months after the definitive surgery, radiographs showed bony union. Two years after the definitive surgery, the plate was removed and limb lengthening was performed with a circular external fixator because of limb shortening. Eight years after the definitive surgery, he enjoyed running
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