Subtrochantäre Femurfrakturen

Abstract

Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

The risk assessment model of fracture nonunion after intramedullary nailing for subtrochanteric femur fracture

“…The incidence of postoperative complications was as high as 21%. [ 5 – 7 ] Previous studies have suggested that there are many factors affecting fracture nonunion after subtrochanteric surgery, including fracture stability (fracture type). [1] The quality of intraoperative fracture reduction, intraoperative minimally invasive or not, and the bone condition of the patient may also affect the nonunion of the fracture.…”

Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur

“…In the case of extramedullary plate and screw system fixation, the moment arm is longer than that in intramedullary fixation [11], with weaker anti-rotation ability and more time for postoperative mobilization. Compared with external medullary fixation, intramedullary fixation can conduct stress more uniformly, which greatly reduces the stress on the internal implant compared with the screw-plate system, thus greatly improving the postoperative stability of fracture and reducing the incidence of complications such as postoperative fracture nonunion and hip varus [12][13][14][15][16].…”

Authors’ reply to Comment on “Does auxiliary cerclage wiring provide intrinsic stability in cephalomedullary nailing of trochanteric and subtrochanteric fractures?”

“…Thereby, only the AO/OTA classification demonstrated significant interobserver reliabilities for all its components, while the validity for the Seinsheimer classification is limited in clinical practice. Although the very common mixed forms of intertrochanteric and subtrochanteric femoral fractures might be better displayed by the Seinsheimer classification [6], the AO/OTA classification is the most widespread and universally used classification worldwide. Since it is generally accepted and includes both trochanteric and subtrochanteric fractures, we have chosen it for the current study.…”