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

In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidityand mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at riskof nonunio‎n complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should becompleted for all patients suspected of nonunio‎n. Failed internal fixation of intracapsular hip fractures is typically treated witharthroplasty, while extracapsular proximal femur nonunio‎ns may be amenable to revision internal fixation or arthroplasty. Whilenot a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and arehistorically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunio‎n given the altered biologicenvironment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Havinga thorough understanding of nonunio‎n risks, recognition, evaluation, and treatment is necessary for appropriate patient care