Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Increasing incidence of subtrochanteric fractures due to aging populations, osteoporosis, and motor vehicle accidents.
• The subtrochanteric region presents unique anatomical and biomechanical challenges for fracture fixation.
• Debate exists regarding the optimal internal fixation device for these unstable hip fractures.

Purpose of the Study:

• To compare the outcomes and characteristics of intramedullary nailing versus open reduction internal fixation (ORIF) for subtrochanteric fractures.
• To evaluate the advantages and disadvantages of each surgical technique in managing these complex fractures.

Main Methods:

• Surgical fixation of subtrochanteric fractures using either intramedullary nails or plate fixation.
• Surgeons' choice of technique based on Seinsheimer's classification and personal preference.
• Evaluation of surgical outcomes, including operative time, complication rates, and weight-bearing status.

Main Results:

• Intramedullary nailing offers benefits such as smaller incisions, reduced operating times, preservation of fracture hematoma, and early weight-bearing.
• ORIF presents disadvantages including longer operating times, increased devascularization, higher infection rates, and delayed weight-bearing.
• Anatomical reduction, often achieved with ORIF, is questioned as a necessary outcome for successful treatment.

Conclusions:

• Intramedullary nailing is a preferred method for treating subtrochanteric fractures due to its favorable clinical outcomes and reduced complications.
• The biomechanical understanding and material improvements in implants have enhanced treatment efficacy.
• Closed reduction and internal fixation via intramedullary nailing is advantageous for unstable fractures, promoting faster patient recovery.