{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:31:21Z","timestamp":1757611881208,"version":"3.44.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>To characterize the rate of failure and risk factors for treatment failure when operatively treating pertrochanteric and intertrochanteric femur nonunions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective cohort study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>One Level 1 North American trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>Patients from 2008 to 2022 presenting with intertrochanteric or pertrochanteric (AO\/OTA 31A1.2\u201331A3.3) nonunions that underwent nonunion repair.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes Measures and Comparisons:<\/jats:title>\n            <jats:p>The primary outcome measure was treatment failure, which was defined as conversion to arthroplasty for reasons other than progression of preexisting arthritis or persistent nonunion 1 year after nonunion repair. Patient demographics, caput-collum-diaphyseal (CCD) angle, the presence of medial bone loss, index implant selection, complications, use of bone graft, and presence of atypical femur fractures were examined for association with treatment failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Sixty-three patients met inclusion criteria and had adequate follow-up to union or treatment failure (average 23.3 months, range 3\u2013129). The mean age was 59 (range 24\u201393, SD 15.6), and 47.6% of patients were male. Forty-two patients (65.1%) were treated with an angled blade plate (ABP) and 19 (30.2%) with a cephalomedullary nail (CMN). The rate of failure was 26.5% (n = 17). In 23.8% of cases, autograft was used (n = 15), 11.1% a synthetic biologic (n = 7), 17.5% allograft (n = 11), and 11.1% with allograft and autograft (n = 7). A biologic augment was more frequently used in patients treated with an ABP versus CMN (71.4% vs. 42.1%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02). Of the 42 patients managed with ABP, there were 14 treatment failures (33.3%), compared with 3 of 19 patients treated with CMN (15.8%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.15). Active tobacco use was associated with treatment failure; 7 of 14 patients went on to treatment failure compared with 10 of 49 without active tobacco use (50% vs. 20.4%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.03). In 14 cases (22.2%), there was medial bone loss noted at the time of revision. 50% of these cases (7\/14) failed to unite compared with 20.4% (10\/49) of patients without medial bone loss (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Despite variations in implant choice, use of biologic augments, and patient age, a failure rate of 26.5% was observed in patients undergoing pertrochanteric and intertrochanteric nonunion repair. Medial bone loss and tobacco use were each associated with a 50% rate of treatment failure, highlighting consideration of these factors preoperatively when considering undertaking nonunion repair.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000003014","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T12:07:54Z","timestamp":1747138074000},"page":"433-439","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Risk Factors for Treatment Failure in Pertrochanteric Nonunion Repair"],"prefix":"10.1097","volume":"39","author":[{"given":"Avrey A.","family":"Novak","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian J.","family":"Vasquez","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David P.","family":"Barei","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael F.","family":"Githens","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250904","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/aja.1000210202","article-title":"The laws of bone architecture","volume":"21","author":"Koch","year":"1917","journal-title":"Am J Anat"},{"key":"R2-20250904","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2106\/JBJS.G.00517","article-title":"Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. 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