PubMed^® Literature Review

Plate augmentation has emerged as a viable strategy in cases where initial treatments have failed or when biomechanical considerations necessitate additional stabilization beyond what intramedullary nailing can provide [1-5].

Subtrochanteric fractures are unique due to their anatomical location and the biomechanical forces involved, often resulting in high rates of complications such as malunion, delayed union, and nonunion [4]. Traditional treatment modalities have included both intramedullary nailing and extramedullary fixation with variable outcomes. In instances where these conventional approaches fail to achieve union or when there is significant comminution making stable fixation challenging, plate augmentation has been proposed as an adjunctive technique [2].

Mittal et al.'s study on refractory aseptic subtrochanteric non-unions treated by dual plating highlights the complexity of managing these injuries [3]. Their approach combined proximal femoral locking compression plates (PF-LCP) augmented by lateral compression plates (LCP), alongside biological interventions such as decortication and autologous bone grafting. This method underscores the necessity for both mechanical stability and biological enhancement to facilitate healing in difficult cases.

Similarly, Lo et al. reported on treating subtrochanteric fracture nonunions with intramedullary devices complemented by augmentation side plating [5]. Their findings suggest that this combination not only provides robust mechanical support but also encourages osseous consolidation within an acceptable timeframe without major complications.

Verma et al.'s research into augmentation plating combined with exchange nailing for failed femoral nailing further supports the utility of plate augmentation in addressing complex nonunions [2]. By augmenting existing intramedullary nails with lateral plates, they achieved union across all cases studied, underscoring the effectiveness of combining internal fixation methods to enhance stability.

The literature consistently illustrates that achieving successful outcomes in subtrochanteric fracture nonunions requires careful consideration of both biomechanical stability and biological healing processes. Plate augmentation offers a promising solution by providing supplementary structural support conducive to bone regeneration—especially critical in scenarios where traditional fixation techniques prove inadequate alone.

In conclusion, while each case must be evaluated individually considering patient-specific factors such as bone quality, comorbidities, and prior surgical interventions; plate augmentation presents a valuable tool in the orthopedic surgeon's armamentarium for managing challenging subtrochanteric fracture nonunions. Future research should aim at prospective comparative studies to better delineate its role relative to other established treatment modalities.