A 29-year-old non-smoking man with a BMI of 37 kg/m2 and history of bipolar disease sustained a right subtrochanteric femur fracture and pseudoaneurysm of his right proximal femoral artery after a gunshot in December 2016.
He was treated with an intramedullary nail. Subsequently, the patient underwent dynamization of his nail secondary to concern for nonunion in May 2017. Five months later, the patient presented to our institution with continued discomfort and radiographs demonstrating persistent nonunion with a 1.3-cm leg-length discrepancy. Labs were notable for a 25-hydroxy vitamin D level of less than 10 ng/mL, and supplementation was initiated. After ruling out infection and correction of nutritional deficiencies, the patient was taken to the OR in December 2017 for hardware removal, repeat biopsy, nonunion repair with grafting (anterior iliac crest bone graft) and proximal femoral blade plate fixation. The surgery was especially complex due to extensive scarring, the patient’s habitus and bony overgrowth at the implant insertion site.