The treatment of nonunion after intracapsular fracture of the proximal femur.

Nonunion is a frequent complication of displaced intracapsular fractures of the femoral neck and occurs in as many as 43% of patients. The incidence can be reduced by prompt anatomic reduction and stable fixation. The treatment of an established nonunion depends on numerous factors including the age of the patient, the vascularity and sphericity of the femoral head, alignment of the neck and shaft, and potential limb length discrepancy. An algorithm constructed from literature-based evidence of the results of available procedures for treatment of nonunion is presented and the roles of refixation, osteotomy, grafting, and prosthetic replacement are considered.