FUNCTIONAL RESULTS OF SURGICAL MANAGEMENT FOR ASEPTIC SUBTROCHANTERIC PSEUDARTHROSIS

Background: Subtrochanteric pseudarthrosis ( non union ) represents a major surgical challenge, occurring in 10% to 20% of subtrochanteric fractures. This study evaluates the anatomical and functional outcomes of surgical management for aseptic subtrochanteric nonunions.
Methods: A retrospective study of 20 consecutive patients with aseptic subtrochanteric nonunions treated over a 10-year period. Clinical and radiological evaluations were performed over a mean follow-up of 40 months. Surgical strategies were tailored according to nonunion type (long Gamma nail, Dynamic Condylar Screw [DCS] plate, decortication, and autologous corticocancellous bone grafting). Outcomes were assessed using ASAMI bone and functional criteria.
Results: Complete bone union was achieved in 85% of cases (n=17) with a mean time to union of 25 months. Persistent nonunion occurred in 3 cases (15%). Varus deformity was noted in 1 case (5%) and limb length discrepancy (>2.5 cm) in 2 cases (10%).
Conclusion: Surgical revision combining rigid fixation, biomechanical optimization, and biological enhancement via autologous bone grafting yields reliable consolidation and functional recovery in complex subtrochanteric nonunions.