Subtrochanteric Fracture Non-Union with Implant Failure Managed with Exchange Intramedullary Nail with Autogenous Bone Graft and Supplement of Bone Morphogenic Protein

We report unusual subtrochanteric non-union and metalwork failure after an index procedure of a trochanteric entry-pointlocked cephalomedullary nailing. We treated this non-union case successfully with the exchange of a thicker and longer intramedullary (IM) nail, supplemented by autologous iliac crest bone graft and bone morphogenic protein 7 (BMP-7). We think the success is due to the optimisation of the mechanical environment (the revision of fixation) along with the enhancement of the biological pathways of bone healing. A single stage surgical revision can be used for recalcitrant atrophic non-union fracture with implant failure.