NON-UNIONS OF THE PROXIMAL FEMUR

Mechanical and biological factors are responsible for non-unions of th e proximal femur. We analyse the causal treatment-possibilities of the different localisations. Fifty-five patients with non-unions of the f emoral neck (average age 53 years) with or without preexistent femoral head necrosis (44%) were treated by abduction osteotomy and followed up at regular intervals. In 15% of cases a second operation was necess ary after an average of 9.3 years, including the early complications. At the latest control 90% of the patients were satisfied, with an aver age Harris hip score (HHS) of 91. The survivorship analysis with end p oint total hip replacement is favourable. In the same period 22 patien ts were treated with a total hip replacement. The 11 survivors had a c learly worse HHS of 65. The low-risk, technically demanding valgisatio n osteotomy should be the first step in the treatment of femoral neck non-unions, even in the presence of femoral head necrosis; secondary o perations are not compromised. Pertrochanteric non-unions are rare. Th e pertrochanteric fragment very often heals, leaving a lateral femoral neck non-union which can be treated with valgisation osteotomy. Depen ding on the type of non-union and the age of the patient, anatomical r eduction, medial displacement and valgisation osteotomy can be employe d. With the angulated plates of the ASIF (95 degrees, 120 degrees, 130 degrees) 23 of the 24 nonunions could be healed in one operation. Fou rteen patients underwent total hip replacement. In the subtrochanteric area mechanical and vascular instability leads to implant failure or fatigue fracture. Rigid compression-reosteosynthesis is the therapy of choice, the 95 degrees condylar plate the implant. Twenty-three of ou r documented 24 subtrochanteric non-unions healed, 4 in the presence o f an infection, Multiple operations have been necessary in 2 of the 4 non-unions following a pathological fracture.