ABSTRACT
INTRODUCTION: The subtrochanteric region is known for its unique biomechanical properties that contribute to challenges in fracture reduction. To ensure optimal fracture healing, achieving robust mechanical stability is essential. There are very few studies in the literature describing the treatment of subtrochanteric fracture nonunion. PURPOSE: To analyze the outcomes of two techniques of revision fixation of nonunion in subtrochanteric femur fracture, namely, nail-plate fixation and plate-structural fibula graft fixation. METHODS: This was a retrospective analysis of subtrochanteric femur nonunion between January 2011 and December 2019. The demographic details, details of the index surgery, details of the revision surgery and the time to final union were collected. The nonunion was divided based on the level of the fracture into high subtrochanteric and low subtrochanteric. Two revision techniques were used: plate-structural fibula graft for high subtrochanteric and nail-plate construct for low subtrochanteric femur fractures RESULTS: Out of the 54 patients that were included, there was malalignment in 53.70 %, medial comminution in 46.3 %, distraction at the fracture site in 44.4 %, lateral trochanteric wall break in 37.03 % and implant failure in 70.37 % of the patients. There were 20 high subtrochanteric and 34 low subtrochanteric fractures. Union was achieved in 53 patients (98.14 %). The mean LEFS score was 71.4 in the nail-plate group and 66.2 in the plate-structural fibula graft group (p 0.003). CONCLUSION: The treatment of subtrochanteric femur fracture nonunion can be a daunting task. The goal is to correct the varus and restore the medial support which will prevent the occurrence of collapse and another failure. We were able to achieve this with both the nail-plate and the plate- structural fibula graft revision methods.
Subject(s)
Bone Nails , Bone Plates , Fibula , Fracture Healing , Fractures, Ununited , Hip Fractures , Humans , Male , Female , Retrospective Studies , Fibula/transplantation , Fibula/injuries , Fractures, Ununited/surgery , Middle Aged , Fracture Healing/physiology , Adult , Hip Fractures/surgery , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/instrumentation , Bone Transplantation/methods , Treatment Outcome , Reoperation , Fracture Fixation, Intramedullary/methods , Fracture Fixation, Intramedullary/instrumentation , AgedABSTRACT
CASE: Two patients who sustained multiple injuries after a road traffic accident developed cutaneous mucormycosis after a superficial abrasion. In the first case, the patient was diabetic with poorly controlled glycemic status. In the second case, the patient was young and immunocompetent with no known risk factors. CONCLUSION: Although there are few case reports of posttraumatic cutaneous mucormycosis, there is no single report describing its occurrence after a superficial abrasion. Cutaneous mucormycosis can be fatal if not identified early and treated aggressively. A high index of suspicion, timely diagnosis, and repeated debridement with antifungal therapy provided good functional outcomes in both patients.
