Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients

Figure 1

(a) A 61-year-old female sustained a syncopal fall at home resulting in a displaced left transcervical femoral neck fracture. She has a history of multiple medical comorbidities including end-stage renal disease on hemodialysis, diabetes mellitus, and hypertension. She subsequently went into PEA arrest twice during transport to the hospital. She was intubated and sedated on arrival. She remained critically injured in the Intensive Care Unit and was deemed an extremely high risk for surgery; therefore surgical intervention was delayed until the patient was medically stable. On hospital day 8, the patient was cleared by the medical service for surgical intervention of her displaced femoral neck fracture, and after extensive conversation with the patient and her family, consent was obtained and surgery was pursued with the plan for hemiarthroplasty given her fracture displacement and delayed presentation to the OR. After induction of anesthesia, the patient was deemed too instable to undergo a hemiarthroplasty, so conversion to closed reduction with percutaneous cannulated screws was chosen, aware of the chance of failure, but choosing this given her medical instability and high risk (b). She was followed in the clinic and over the following 7 months continued to have groin pain with ambulation and radiographic signs of hardware failure and nonunion (c). During this time, she had extensive medical optimization in anticipation of revision surgery. When deemed medically optimized and cleared for surgery, after discussion with the patient and her family, she was brought back to the OR for hardware removal and left hip hemiarthroplasty (d). She tolerated the procedure without complications and is ambulating with minimal pain postoperatively.

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