Subtrochanteric Non-Union - Failure to Function
Amol Yashwant Patil1*, Sushrut Babhulkar2, Nitin Kimmatkar3, Aniruddha Sonegaonkar4
1Ganga Clinic and Sushrut Institute of Medical Sciences, Nagpur, India.
2Sushrut Institute of Medical Sciences, Nagpur, India.
3Indira Gandhi Government Medical College & Mayo General Hospital, Nagpur, India.
4NKP Salve Medical College and Lata Mangeshkar Hospital, Nagpur, India.
*Corresponding Author: Dr Amol Patil, MBBS, D-Orth, DNB (Orth), M. Ch (Orth), Ganga Clinic, 3545/B/6, Samaj Ekta Society, Ganga Clinic Road, New Manish Nagar, Somalwada, Nagpur PIN – 440005, India.
https://doi.org/10.58624/SVOAOR.2025.05.019
Received: October 09, 2025
Published: October 29, 2025
Citation: Patil AY, Babhulkar S, Kimmatkar N, Sonegaonkar A. Subtrochanteric Non-Union - Failure to Function. SVOA Orthopaedics 2025, 5:5, 115-122. doi: 10.58624/ SVOAOR.2025.05.019
Abstract
Objective: To introduce Ten Commandments for management of Subtrochanteric Non-union.
Design: Prospective study of 56 patients treated from January 2018 to December 2023. All 56 patients were managed by following “Ten Commandments “postulated to give consistent results in subtrochanteric non-unions. Aim was to achieve anatomic reduction, absolute stability, compression at fracture site, stimulation of biology, eradication of infection (if present), soft tissue coverage. Regular follow up for wound healing, fixation failure, infection control, healing of non-union done with minimum follow up for 24 months.
Setting: Multicentetic
Patient Selection Criteria – Patients between 18 to 60 years with subtrochanteric non-union (Septic & Aseptic) included with minimum follow-up of 24 months. Patients with non-unions of pathologic fractures, chronic kidney & liver disease excluded.
Outcome Measures and Comparisons - Functional assessment done by Parker Mobility Score (PMS).
Results: “Ten commandments” introduced in this study takes care of all the mechanical and biological factors responsible for non-union. PMS in all patients were encouraging. All patients reached the pre-injury level of activity. No patient had limp, deep vein thrombosis, osteonecrosis,
Conclusions: “Ten commandments (PEEDACASSS)” paves the way for managing subtrochanteric non-union with predictable results. Biology and mechanical interplay need to be set at a tune to lead bony union. Debridement, reconstruction of medial pillar and shingling being the most critical steps.
Level of Evidence – Level II
Keywords: Subtrochanteric non-union, Ten commandments, PEEDACASSS,