Subtrochanteric fractures. A review of treatment options

Subtrochanteric fractures of the femur were originally grouped with comminuted intertrochanteric fractures. However, they pose their own distinct management problems mainly due to biomechanical differences in stability and are now considered separately. There are several classification systems but the most widely accepted is the one proposed by Seinsheimer in 1978. Many different methods have been employed in the management of this group of fractures with varying rates of success. The management has altered as new implants have been developed to try to overcome the shortfalls of the existing implants. This study is a review of the literature and was carried out using Medline and the Cochrane Library to look at the management methods employed in the past and today. Most of the published articles are retrospective uncontrolled reports of the results of management and it is difficult to suggest management principles from them. The other main shortcoming is that, although there are several devices available on the market for the management of these fractures, most of the literature concerns one or two of them. The results reported examine union rates and failure of implants leading to reoperation. This is a crude outcome measure, and there is very little in the literature regarding patient function. In order to provide evidence-based advice on the best management options for these difficult fractures, future studies should be designed as randomized controlled trials and place more emphasis on studying patients' outcomes.