Intramedullary Versus Extramedullary Fixation for Subtrochanteric Femur Fractures

Abstract

There is grade B evidence that operative time is reduced and that fixation failure is reduced with the use of intramedullary implants for subtrochanteric fractures. Future studies should perform subgroup analysis according to the type of population sampled (ie, young versus elderly) and subtrochanteric fracture type.

TRIGEN INTERTAN Intramedullary Nail Versus Sliding Hip Screw

“…However, in our view, the scientific evidence from well-designed clinical studies supporting the exclusive use of intramedullary nails in this subgroup of fractures is lacking. Recent meta-analyses also demonstrated that more high-quality studies are required before definitive conclusions regarding implant selection for these fractures can be drawn 1,29,31 . We have continued to favor the use of the sliding hip screw for these fractures, but we are using an additional trochanteric stabilizing plate to prevent excessive medialization of the femoral shaft.…”

Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

“…However, other studies [2,7,22,40] have concluded there is no clear benefit of cephalomedullary nailing versus extramedullary implants. It seems that intramedullary implants are beneficial in subtrochanteric and unstable fracture types [19,31]. Among the latter are transverse or reverse oblique but also multifragmentary fractures that sustain intra-or postoperative shattering of the lateral trochanteric wall.…”

Acute intimal flap tear of the external iliac artery in an open subtrochanteric femur fracture: A case report

“…Intramedullary nails are generally favoured due to their decreased surgical time and arguable superior strength of fixation. 7,8 In fractures with a concurrent vascular injury with loss of extremity perfusion, emergent restoration of flow is paramount. Whilst initial arterial assessment and ankle-brachial index may be normal, delayed thrombosis from intimal injury has been described.…”