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Subtrochanteric fractures: current management options.

Niall J A Craig1, Nicola Maffulli

  • 1Grampian University Hospital, Aberdeen, UK.

Disability and Rehabilitation
|November 10, 2005
PubMed
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Subtrochanteric femur fractures require specific management. Operative treatment, particularly with intramedullary devices, generally yields better outcomes than conservative approaches for these complex fractures.

Area of Science:

  • Orthopedic surgery
  • Traumatology
  • Biomechanics

Background:

  • Subtrochanteric femur fractures present unique challenges distinct from other proximal femoral injuries.
  • Understanding these differences is crucial for effective treatment and avoiding complications.

Purpose of the Study:

  • To comprehensively review current management strategies for subtrochanteric femur fractures.
  • To compare the efficacy and outcomes of various conservative and operative treatment modalities.

Main Methods:

  • A systematic literature search was conducted using Medline to identify relevant studies.
  • Papers were assessed for information on subtrochanteric fracture management, categorized by treatment type (conservative vs. operative).
  • Operative techniques were further classified based on implant type: extramedullary and intramedullary devices.

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Main Results:

  • Conservative management achieved satisfactory results in 56% of patients, whereas operative methods reported 70-80% success rates.
  • Intramedullary devices demonstrated superior outcomes compared to extramedullary devices, especially when the medial buttress is compromised.
  • Conservative treatment is associated with low non-union rates and is suitable for specific patient groups and settings.

Conclusions:

  • Operative management, particularly with intramedullary fixation, generally offers better outcomes for subtrochanteric femur fractures.
  • Conservative management remains a viable option for select patients, including children, those unfit for surgery, or in resource-limited areas.
  • Surgeons should utilize techniques with which they are most familiar for operative interventions to maximize success rates.