Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases

Reducing Subtrochanteric Femur Fractures

“…[1][2][3][4] Although several methods of treatment options have been reported in the recent literature, our preference is to use reamed, antegrade intramedullary nailing (IMN). Although early fixation options led to implant failure and high rates of nonunion, advances in implant technology in addition to an improved understanding of the proximal femoral anatomy have led to a successful modern treatment paradigm.…”

“…Although early fixation options led to implant failure and high rates of nonunion, advances in implant technology in addition to an improved understanding of the proximal femoral anatomy have led to a successful modern treatment paradigm. 2,3,5,8,9 Furthermore, combining intimate knowledge of the surrounding anatomy with a few technical tricks, desired outcomes can be achieved while avoiding pitfalls and known complications. 1,3,[5][6][7] Arguably the standard of care in treating subtrochanteric femur fractures, IMN can lead to reliable reproducible results.…”

“…10 A recent meta-analysis compared reported outcomes between screw-and side-plate constructs to blade plates and IMN. 2,5,7,9,11,12 Biomechanically, IMN fixation is superior for several reasons. 10 Blade plates, despite inferior results to IMN, still warranted some favor from the authors with satisfactory outcomes.…”

“…However, despite theses favorable results, there are several advantages to the use of an IMN. 1,2,11,17 Anatomic Considerations: Importance of the Start Point Some of the highest tensile and compressive mechanical forces in the human body occur across the proximal femur. First, its increased rigidity, stiffness, and shorter moment arm allows for a biomechanically stronger construct with decreased strain placed on the implant.…”

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them

“…A femoral distractor can also be used to align the fragments. Careful open reduction with minimal additional soft tissue insult is also an acceptable method [80].…”