Search Results (91)

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient’s quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations—an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a decade (2004–2015) and patients who were treated for acute metastatic spinal compression (AMSCC) (2007–2017) were retrieved. There were no patients lost to follow-up. Results: The treatment cohorts were similar in terms of age, gender, tumour origin, and the number of spinal metastases. Fifty-four patients were diagnosed with AMSCC. Following treatment, the Frankel muscle grading improved by 0.5 ± 0.8 grades. Two hundred and eighteen patients underwent surgical intervention for FMD. Seventy percent of femoral metastases were located in the femoral neck and trochanteric area. Impending fractures accounted for 52% of the cohort. The FMD cohort, including impending and pathological fractures, was similar to the AMSCC cohort in terms of age and the time interval between cancer diagnosis and surgery (56.7 ± 74.2 vs. 51.6 ± 69.6, respectively, p = 0.646). The Karnofsky functional score was higher for the FMD cohort (63.3 ± 16.2) than for the AMSCC cohort (48.5 ± 19.5; p < 0.001). The mean survival time for the FMD cohort was double that of the AMSCC, at 18.4 ± 23.5 months versus 9.1 ± 13.6 months, respectively (p = 0.006). Conclusions: In conclusion, this study is novel in proposing that FMD and AMSCC are distinct clinical entities, differing in their impact on patient function and, most importantly, on patient survival. Full article

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Background: Femoral neck fractures (FNF) have high mortality rates. Surgical delay likely contributes. Dynamic hip screw (DHS) fixation is common for FNF, and the tip–apex distance (TAD) measures screw position in the femoral head. A TAD >20–25 mm is considered a risk factor for screw cut-out. This study investigated the association between (1) surgical delay and complication/mortality rates within two years post-surgery and (2) TAD and postoperative complications following DHS in FNF. Methods: This retrospective study included 325 FNF patients who underwent DHS osteosynthesis at Regional Hospital Randers, Denmark from 2015–2021. The primary composite outcome included complications measured on radiographs (e.g., screw cut-out, avascular necrosis), reoperation, or death within 2 years. Radiographs were evaluated for TAD and postoperative complications/reoperations. Surgical delay was defined as the time from the diagnostic radiograph to the start of the operation. TAD was measured based on radiographs. Electronic patient journals and national SSN registers were used to assess reoperation and death rates. Results: The mortality rate was 16% within 1 year and 26% within 2 years. The complication rate was 16% within 2 years. The median surgical delay was 7.9 h (IQR 5; 14). Surgical delay was significantly associated with the 1-year mortality rate (p < 0.01), but not with the 1-year complication rate (p = 0.77). Surgical delay was associated with complication rates 2 years post-surgery only for undisplaced fractures, p = 0.046. The median TAD was 16.3 mm (13.8; 18.7); no association with complications <1 year (p = 0.56) or <2 years (p = 0.99) was observed. There were 59/325 patients with TAD >20 mm, six of whom had complications, and 6/59 with TAD >25 mm, none of whom had complications. Conclusions: We report a significant association between surgical delay and mortality rates in FNF, despite surgical delays <24 h. Additionally, there was a significant association between surgical delay and risk of complication/reoperation 2 years post-surgery for undisplaced fractures. No association was found between TAD and complication rates following DHS fixation for FNF; however, only a few TAD outliers were observed. Full article

Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12–57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional “fix or replace” to a more integrated “fix and replace” approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0–3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient’s needs, and advancing care for complex acetabular fractures. Full article

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines. Full article

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients’ mean age at the time of surgery was 55.6 ± 14.1 years (range, 33–71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations. Full article

Background: Osteoporotic hip fractures in the elderly significantly impact mobility and quality of life. Optimising early management is crucial for improving the functional outcomes. Methods: This single-centre retrospective cohort study included patients with femoral trochanteric (n = 142) or femoral neck fractures (n = 127) treated between January 2016 and March 2023. The patients were divided into ambulatory and non-ambulatory groups based on their walking ability at discharge from the rehabilitation hospital. The explanatory variables included age, sex, fracture type, surgical method, pre-surgical days, hospital days, dementia, and the Nursing Needs Score (NNS). Results: The most common age group was 85–89 years old. Only 23.4% of patients underwent surgery within 2 days of admission. The median hospital stay was 20 days in acute care and 52 days in rehabilitation hospitals. Walking ability declined in 66.9% of the patients. Pre-injury mobility and acute care hospital NNS were identified as independent predictors of ambulatory outcomes. Conclusions: Pre-injury mobility and the Nursing Needs Score (NNS) assessed at the acute care hospital were identified as critical determinants of postoperative ambulatory status. These findings highlight the importance of community collaboration and preventive rehabilitation strategies aimed at improving basic mobility, maintaining cognitive function, and preserving walking ability. Full article

Background: This institutional, register-based analysis aimed to evaluate the feasibility of using CT-based sacral Hounsfield units (HUs) for assessing bone density in pelvic fragility fractures and to explore their potential correlation with DEXA measurements and osteological laboratory diagnostics. Methods: Patients aged > 80 years, admitted between 2003 and 2019 with pelvic ring fractures, were analyzed in this retrospective single-center study. CT scans were evaluated according to the classification of fragility fractures of the pelvis (FFPs), which guided treatment decisions (conservative or surgical). The diagnosis of a fragility fracture was based on both fracture morphology and patient history, including the presence of low-energy trauma. Bone health was assessed using standardized laboratory diagnostics including serum calcium, phosphate, alkaline phosphatase, and 25(OH)-vitamin D, in addition to DEXA scans and CT-derived Hounsfield units. Vitamin D levels and bone density evaluations were analyzed to identify possible correlations among these factors and with fracture patterns. Results: A total of 456 patients (mean age 87.3 years, 79.6% female) were included. The CT-based FFP classification identified Type II as the most common fracture type (66.7%). Conservative treatment was the predominant approach (84.9%). Serum 25(OH)-vitamin D deficiency was observed in 62.7% of the patients, while osteopenia and osteoporosis were found in 34.3% and 46.5% of cases, respectively. HU values at S1 showed significant correlation with femoral neck T-scores, highlighting the utility of CT scans for bone density assessment. Conclusions: This study emphasizes the complementary roles of CT-derived HU values and DEXA T-scores in evaluating bone quality and fracture severity in geriatric patients with FFP. While DEXA remains the gold standard, CT imaging offers valuable early insights, supporting the timely initiation of osteoporosis therapy. Given the high prevalence of fragility fractures in this age group, early CT-based screening may facilitate earlier initiation of osteoporosis-specific therapy, including anabolic agents where indicated. Further research is needed to explore the relationships between vitamin D levels, bone density assessments, and fracture types. Full article

Introduction: Intertrochanteric femoral fractures (IFFs) are the most common traumatic injuries in elderly people and significantly impact the patient’s health status. The current evidence indicates that short intramedullary nails may be a better choice than dynamic hip screws in IFF management, being less invasive and biomechanically superior, providing a buttress to limit fracture collapse. On the other hand, an unstable fracture may collapse even after adequate reduction and fixation. This paper aims to describe the surgical complexity of the nail-to-total hip arthroplasty (THA) conversion, focusing on the restoration of normal hip geometry. Material and Methods: Patients referred to our level I trauma center with failed cephalomedullary nailing following IFFs and managed with the nail-to-THA conversion were retrospectively recruited. The anteroposterior postoperative pelvis radiographs were analyzed to establish whether the normal biomechanics of the involved hip were restored. The following radiographic parameters were recorded and compared to the contralateral unaffected side: hip offset, cervical–diaphyseal angle, and limb length discrepancy. Clinical assessment was performed using the following scores: the Harris hip score (HHS) and the visual analog scale for pain (VAS). The independent samples t-test and the Pearson correlation test were performed. The tests were two-tailed; a p < 0.05 was considered significant. Results: A total of 31 patients met the inclusion and exclusion criteria (10 males and 21 females; mean age: 76.2 years; range: 66–90 years) and were included in this study. The modes of trochanteric nail failure included the following: cut-out in 22 cases (70.97%), non-union in 4 cases (12.9%), peri-implant fracture in 1 case (3.23%), cut-through in 2 cases (6.45%), and femoral head avascular necrosis (HAN) in 2 cases (6.45%). Long stems were used in 21 patients out of 31 (67.74%), while dual-mobility cups were implanted in 24 patients out of 31 (77.41%). A significant mean neck shaft angle (NSA) increase (p < 0.001) and a significant mean femoral offset reduction (FO, p 0.001) compared to the contralateral hip were recorded; a mean limb length discrepancy (LLD) of 8.35 mm was observed. A significant correlation between HHS and ∆NSA (p = 0.01) and ∆FO (p = 0.003) was recorded. Conclusions: Conversion from a cephalomedullary nail to THA is a complex procedure that should be considered a revision surgery, rather than a primary surgery. Surgeons must be aware that normal hip geometry may not be obtained during this surgical procedure; thus, a patient undergoing the nail-to-THA conversion for intertrochanteric fixation failure may have an increased risk of implant-related complications. Full article

Proximal femoral fractures (PFFs) are the most frequent type of bone injury among the elderly. In Italy alone, 906,111 hospital admissions for hip fractures were recorded between 2007 and 2017. Globally, due to the aging population, the number of cases is expected to rise to 21.3 million by 2050. In older individuals, fractures of the femoral neck are commonly managed with prosthetic implants. While hemiarthroplasty has long been the standard treatment, total hip arthroplasty (THA) is increasingly favored for more active or functionally demanding patients. Among the surgical options, dual mobility THA (DM-THA) stands out for its potential to significantly reduce postoperative complications, particularly dislocations, when compared to both conventional THA and hemiarthroplasty. This study aimed to determine the most effective surgical strategy—dual mobility THA versus hemiarthroplasty—for managing femoral neck fractures in elderly patients. A thorough literature review was conducted using PubMed, Web of Science, and Scopus, focusing on the most recent and relevant publications. The findings highlight a consistent trend: patients treated with DM-THA generally experience better outcomes than those receiving hemiarthroplasty. Based on current evidence, DM-THA should be regarded as the preferred intervention for elderly individuals with femoral neck fractures, except in cases where severe comorbidities or anesthesia-related risks require a more conservative approach. Full article

Background/Objectives: Osteoporosis is prevalent in the elderly and increases fracture risk. Bone density is commonly assessed using dual-energy X-ray absorptiometry (DEXA). The femoral cortical thickness index (CTI) also provides indirect information for osteoporosis. It remains unclear whether there are intra-individual differences and if a correlation to fracture risk of the CTI in fractured femora results due to fracture related malrotation during X-rays. The aim of this study was to investigate the individual bilateral CTI in patients with proximal femoral fractures. Methods: A retrospective analysis of 200 surgically treated patients (100 trochanteric, 100 femoral neck fractures) was performed. Measurements included the bilateral CTI at 10 and 15 cm below the lesser trochanter. Analysis of the correlation of those examinations, in comparison to the contralateral CTI at 15 cm, and correlation of the CTI with the body mass index (BMI) and age was performed. Results: Results showed significant differences (p < 0.001) in bilateral CTIs for both fracture types at 15 cm with a strong inter-rater reliability (ICC > 0.9). There was no significant correlation between age and CTI, as well as BMI and CTI in both cohorts (p > 0.1). Sex-specific subgroup analyses revealed that females exhibited significant differences in CTI between fractured and non-fractured sides (p < 0.001). Conclusions: In conclusion, CTI, and the modified CTI at 15 cm below the lesser trochanter in fractured proximal femora, is lower compared to the non-fractured side. The femoral CTI could help in daily clinical routines and circumstances, where more detailed risk prediction tools are lacking. Full article

Background: Displaced femoral neck fractures (FNFs) can be treated with hemiarthroplasty (HA) or total hip arthroplasty (THA), with THA typically offered to fitter patients. Sarcopenia increases complications and mortality after hip arthroplasty. The psoas muscle–L3 vertebra ratio (PML3) is a sarcopenia marker. This study evaluated PML3’s role in predicting postoperative outcomes and guiding surgical decision-making. Methods: A retrospective study was conducted at a single centre between January 2021 and December 2024. PML3 was measured on computed tomography (CT) at the L3 vertebra level for patients with displaced FNFs, comparing postoperative outcomes between HA and THA cohorts. Results: Eighty-three patients (fifty-seven female, twenty-six male) were analysed. Forty-three underwent THA, and forty underwent HA. Postoperative complications were higher in HA patients (48% vs. 21%, p = 0.019), with lower 30-day survival (90% vs. 98%). Median PML3 in the HA group was 0.70 mm² (IQR: 0.47–1.47), lower than in the THA group (1.34 mm², IQR: 1.00–1.78, p = 0.002). However, PML3 values for patients that suffered complications (irrespective of surgical decision) were essentially the same; HA, 0.57 mm² (IQR: 0.43–1.83); THA 0.56 mm² (IQR: 0.41–1.05, p = 0.847). ROC analysis showed PML3 as an acceptable predictor of postoperative complications, with an AUC of 0.71. Conclusions: Lower PML3 values correlate with higher postoperative complications and mortality following THA or HA for displaced FNFs, confirming its role as a prognostic marker. Some THA complications in low-PML3 patients might have been avoided by selecting less invasive HA, suggesting THA should be reserved for those with greater muscle reserves. Full article

Objective: To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries. Study Design: This is a retrospective cohort chart review study. Methods: A retrospective review was conducted for patients admitted with gunshot wounds (GSWs) to the head, neck, or face between January 2013 and March 2020 at a level one trauma tertiary care hospital. Univariate and multivariate analysis were performed to identify associations with surgical repair and LOS. Results: Of the 578 patients with head, neck, or facial GSWs, 204 survived and sustained facial fractures. The maxilla (n = 127, 62%), orbit (n = 114, 55%), and mandible (n = 104, 51%) were the most fractured. Operative rates differed by location (p < 0.001) with highest rates for fractures involving the mandible (76%). In univariate analysis, overall facial fracture surgery was associated with transfacial injuries; mandible, palate and nasal fractures; tracheostomy; gastrostomy tube placement; ICU admission; and a longer-than-24 h ICU stay (all p < 0.05). In multivariate analysis, predictors of surgical repair included a length of stay greater than 3 days (OR 2.9), transfascial injury (OR 3.7) and tracheostomy placement (OR 5.1; all p-values < 0.05), while nasal and mandible fractures were also associated with overall operative repair (OR 2.5 and 9.3, respectively; p-value < 0.05 for both). Univariate analysis showed that among patients with GSW injuries who underwent facial plastic reconstructive surgery (FPRS) with comorbid serious polytrauma, the inpatient LOS was predicted solely by the presence of subarachnoid, subdural and intracranial hemorrhage (p-value < 0.005). Subsequent multivariate analysis found that the only predictor for greater hospital LOS for patients who underwent surgical repair was earlier timing to FPRS of less than five days (OR 0.17) and placement of a gastrostomy tube (OR 7.85). Conclusions: Managing facial fractures in GSW patients requires complex medical decision making with a consideration of functional and esthetic outcomes in the context of concomitant injuries and overall prognosis. Certain characteristics such as ICU admission, longer hospital stay, trajectory of GSW, tracheostomy placement, and specific operative locations are associated with higher rates of operative repair. Inpatient hospitalization LOS for patients who underwent FPRS was predicted by timing from admission to surgical repair. Full article

Background: The optimal treatment decision for pediatric condylar fractures is influenced by various factors, including the child’s age, fracture type, degree of displacement, and the presence of concomitant injuries. While non-surgical treatments are generally preferred due to high remodeling capacity in children, there remains a lack of comprehensive research comparing the long-term outcomes of open reduction internal fixation (ORIF) versus conservative management. Methods: Retrospective analysis of medical records of 71 pediatric patients (aged 0–18 years) treated for condylar fractures at the Department of Oral and Maxillofacial Surgery, Rambam Healthcare Campus, between 2010 and 2020 was completed. Gender, age, admission date, cause of injury, treatment methods, length of hospital stay, follow-up duration, and follow-up status were studied to help determine association with modality of treatment and complications. Results: No statistically significant differences were seen in complication rates across different age groups, genders, trauma etiologies, fracture sites (head/neck/base), laterality of fractures, nor was there an impact on choice of surgical vs. conservative intervention. Similar length of hospital stay was observed, even in cases with delayed surgical intervention. There was also no statistical significance of injury distribution based on socioeconomic standing. Conclusions: Our research showed similar rates of complications in both surgically treated and conservatively treated cases. This solidifies the importance of practitioner experience, as well as comprehensive anamnesis to help caretakers most effectively determine the optimal treatment for each patient. As the surgical study group is substantially smaller than the conservatively treated group, large-scale prospective studies with extended follow-up will more conclusively help solidify results and establish guidelines. Full article

Subtrochanteric nonunion is especially challenging. Extramedullary fixation using fixed-angle devices with a closing lateral wedge osteotomy is the standard surgical procedure for restoring the hip’s normal alignment and achieving bone union. However, this procedure is technically demanding and relies on devices that facilitate bone union in a non-dynamic manner, along with the limitations that this type of fixation entails, especially in this highly biomechanically stressed area. This paper aims to describe a novel surgical technique to heal subtrochanteric nonunion based on dynamic fixation performed through an over-valgus correction of the hip and fixed with a dynamic hip screw (DHS). Between March 2022 and July 2023, five patients diagnosed with nonunion of a subtrochanteric fracture were operated on by a single surgeon and followed prospectively. The average age of the patients was 64 (range: 34–85). The mean duration of surgery was 112 min (range: 63–153). The femoral neck angle before surgery was 120° (range: 110°–122°) and 147° (range: 142°–150°) after surgery. The mean leg length increased by 8 mm (range: 6–12). The Harris hip score improved from 38 points (range: 30–44) to 90 points (range: 88–96), corresponding to excellent or good results. All patients healed without major complications and were asymptomatic after 12 months of follow-up. In conclusion, over-valgus correction using a DHS is a novel technique that seems helpful for subtrochanteric nonunion. It allows for dynamic fixation, offering the advantages of dynamic fixation, especially in this high-stress area. It is also performed without osteotomy, making it a less demanding technique than the current methods described. Full article