Dynamic Valgus Correction for Nonunion of Subtrochanteric Hip Fractures

The objective is to describe a new technique for subtrochanteric hip nonunions. Three patients with a nonunion of a previously nailed subtrochanteric hip fracture were selected. The nail was withdrawn, and a simple lateral approach was performed. A hip screw was introduced through the neck, and a dynamic plate (135-150º) was applied, to increase the femoral-neck angle (valgus) and reduce the head offset at the hip. The correction was achieved just by mobilizing the nonunion site. No osteotomy was done. Fixation promoted dynamic mechanical compression and fracture healing. The mean age of patients was 57 (34-85). 2 women, and one man. Duration of surgery was 102 min (63-123). Femoral neck angle before surgery was 125º (122-128), and after surgery 147º (142-150). Offset was 50 mm (42-59) before surgery and 20 mm (19-24) after surgery. Leg length was increased by 8,6 mm (6-12). Harris hip score was improved from 37,33 (30-42) to 93,33 (88-96). All patients healed and were asymptomatic after 12 months follow-up. In conclusion, valgus correction with a dynamic hip screw is a useful technique for a nonunion of a subtrochanteric hip fracture. This zone is well vascularized, so just dynamic mechanical compression at the fracture site is needed.