Subtrochanteric femur fractures: current review of management

Abstract

Subtrochanteric (ST) femur fractures are proximal femur fractures, which are often difficult to manage effectively because of their deforming anatomical forces. Operative management of ST fractures is the mainstay of treatment, with the two primary surgical implant options being intramedullary (IM) nails and extramedullary plates. Of these, IM nails have a biologic and biomechanical superiority, and have become the gold standard for ST femur fractures. The orthopaedic surgeon should become familiar and facile with several reduction techniques to create anatomical alignment in all unique ST fracture patterns. This article presents a comprehensive and current review of the epidemiology, anatomy, biomechanics, clinical presentation, diagnosis, and management of subtrochanteric femur fractures. Cite this article: EFORT Open Rev 2021;6:145-151. DOI: 10.1302/2058-5241.6.200048

External Locking Plate Fixation for Femoral Subtrochanteric Fractures

“… 22 In terms of age, approximately two-thirds of STF occurs in elderly patients (>50 years old). 4 In consideration of high mortality rate and immobilization-related complications under conservative treatment, surgery is recommended by most of surgeons in the literature to allow early mobilization and reduce fracture related complications. 4 - 6 In operation treatment, closed or open reduction followed by internal fixation with various implants such as fixed angle plate, intramedullary nailing, or locking plate are the standard treatments for STF.…”

“… 4 In consideration of high mortality rate and immobilization-related complications under conservative treatment, surgery is recommended by most of surgeons in the literature to allow early mobilization and reduce fracture related complications. 4 - 6 In operation treatment, closed or open reduction followed by internal fixation with various implants such as fixed angle plate, intramedullary nailing, or locking plate are the standard treatments for STF. 4 - 6 However, some fragile patients with severe comorbidities can complicate the anaesthesia process and post-operative care.…”

“… 4 - 6 In operation treatment, closed or open reduction followed by internal fixation with various implants such as fixed angle plate, intramedullary nailing, or locking plate are the standard treatments for STF. 4 - 6 However, some fragile patients with severe comorbidities can complicate the anaesthesia process and post-operative care. Hence, significant post-operative morbidity and mortality has still been a concern in recent decades even with the advancement of medicine and implants.…”

“… 3 It mainly affect elderly patients and almost all patients require surgical treatment. 4 Performing operations for these fragile patients remains a challenge even with the advance of peri-operative care and anaesthesia technique. High post-operative complications and mortality rates are still noted in literature.…”

Outcome of Subtrochanteric Femur Fractures Treated by Proximal Femoral Nail in a Tertiary Care Hospital

“…5 Because the surgeon should be aware of the adjustable elements that can improve surgical results, such as nail entrance site and construct design, fracture reduction and stability can be affected. 6 An unfavourable entrance location at the greater trochanter is typically the source of operational complications when applying Femoral locking nails. The nail is required to follow the cortical abutted medullary canal, especially in fractures that are further away.…”