Revision surgery in a middle-aged patient with pertrochanteric fracture nonunion due to wedge effect caused by cephalomedullary nail: A case report

Trochanteric femur fractures have traditionally been treated surgically with compression hip screws or cephalomedullary nails. With the increasing use of cephalomedullary nails, potential complications from this technique have surfaced. One of them is the potential for varus malreduction of trochanteric femur fractures, known as the “wedge effect”, which is the distraction of fracture fragments generated during reamer and nail passage resulting in varus malalignment at the neck-shaft angle. Although trochanteric nonunion in the non-elderly is exceedingly rare, we experienced one such case after nailing due to the wedge effect that was subsequently successfully treated with a compression hip screw without bone grafting. Therefore, in the case of stable pertrochanteric fractures (AO/OTA 31A1) in younger patients, compression hip screw surgery may be the better choice of initial surgery to avoid later nonunion.