(P 485) SUBTROCHANTERIC NON-UNION AFTER INTRAMEDULLARY NAILING DUE TO PATHOLOGICAL FRACTURE:PROXIMAL FEMORAL REPLACEMENT AS A SALVAGE APPROACH

Objective: To assess proximal femoral replacement as a treatment solution for nonunion of pathologic subtrochanteric fractures after cephalomedullary nailing in patients with pathological fracture and previously irradiated bone.

Methods: Retrospective review of five patients with pathological subtrochanteric femoral fractures that were treated with cephalomedullary nailing and developed a nonunion, which was revised with conversion to a proximal endoprosthetic replacement between September 2020 and June 2021.

Results: Preoperative radiographs demonstrated hardware failure in all five patients (Figure 1). All five patients had previously been treated with radiation (Figure 2). One patient had latest follow-up at 2 months postoperatively. At that time, the patient was walking with a walker for assistance, with no evidence of hardware failure or loosening on imaging. The remaining four patients had latest follow-up ranging from nine to fifteen months after surgery. At their latest follow-up, three of the four patients were ambulatory with no pain, using only a cane for assistance with longer distances. The other patient demonstrated pain in his affected thigh, utilizing a walker for assistance with ambulation at latest follow-up, but not requiring further
surgical interventions. There were no hardware failures or implant loosening on imaging at latest follow-up (Figure 3). None of the patients required revision and there were no postoperative complications observed at their last follow-up.

Conclusion: In patients with pathological fractures in the subtrochanteric region that are treated with cephalomedullary nailing and developed a nonunion; treatment with conversion to a proximal femoral replacement with a mega prosthesis is a valuable treatment with good functional results and low risk for complications.