A New Dynamic Technique for Healing Aseptic Subtrochanteric Hip Nonunion: Detailed Technique and Review of Literature

Background and Objectives: Subtrochanteric nonunion is a challenging problem. Several techniques have been employed in the literature to address this problem, yielding var-ying results. The objective of this review is to present the surgical details of a new technique recently developed, and to analyze the literature about surgical techniques applied to this problem to date. Materials and Methods: The detailed surgical technique of a new, dynamic system to fix subtrochanteric nonunion is presented. All literature regarding nonunion fixation of subtrochanteric nonunion was revised from 2000 to August 2025. Only papers with 2 or more patients treated by fixation of an aseptic subtrochanteric nonunion were selected. Varus and shortening correction, debride-ment, use of bone graft, type of device, and immediate weight bearing were searched for and analyzed in every paper. Results: 347 papers were fully reviewed. 26 finally met the inclusion criteria. Varus correction was not always necessary, but when re-quired, extramedullary systems achieved better correction. Leg shortening was over-looked by most papers, which accepted the shortening of the involved leg. Most papers use debridement and several types of bone grafts. It seems useful in atrophic nonunion, but not in hypertrophic ones. All devices but one worked in a nondynamic compres-sion way. Most systems do not allow for immediate weight bearing, which is important for elderly people. Conclusions: The new dynamic technique for healing of subtrochan-teric nonunion fulfills all the requirements to solve this problem: 100% healing, varus and leg length correction, and immediate weight bearing. As few patients have been reported with this technique, a prospective study is warranted.