Plate-tensioned reconstruction nail for proximal femur diaphyseal nonunion

A “plate-tensioned nail” implant construct is described as a single-stage salvage procedure for proximal femur diaphyseal nonunion. This construct combines the stability of a medullary nail with the compression afforded by a tension band, permitting immediate full weight bearing. The proximal hole of a 4.5-mm plate is modified to accept a 6.5-mm recon screw placed through the plate and nail into the femoral neck and head. Plate-based compression or an articulated tensioning device is used to compress across the nonunion site while affixing the plate to the lateral femoral diaphysis. Eight adults (7 men) of a mean age 49.5 years (range 19–81 years) with proximal femur diaphyseal nonunion were treated with a plate-tensioned nail construct supplemented with bone autograft (mean 27 cc, range 10–40 cc). The mean days to ambulation after repair was 1.1 (range 1–2). All patients progressed to clinical union within 4 months with no occurrence of mortality, implant failure, recalcitrant nonunion, periprosthetic fracture, or deep surgical site infection within 4 months (mean modified RUST score 13.6, range 12–16). One patient experienced a superficial surgical site infection at the bone graft harvest incision treated with oral antibiotics.