Radiographic and clinical outcomes of traumatic subtrochanteric femur fracture fixation and reduction methods

Different reduction methods and implant choices for subtrochanteric femur fractures with varying fracture patterns have been described. This study aimed to assess the relationship of fracture patterns, reduction methods, and implant selection with radiographic and clinical outcomes.

A retrospective review of patients aged ≥ 18 with traumatic subtrochanteric fractures between 2016 and 2023 at a Level-1 trauma center was conducted. Patient, surgical, and outcome characteristics were collected. Femoral neck-shaft angle , maximum sagittal cortical displacement, and modified radiographic union score of the tibia (mRUST) adapted to the proximal femur were measured on post-operative radiographs.

Among 64 patients (mean age 56.1, 70.3% male) with one patient with bilateral injuries, 54 received an intramedullary nail (IMN), 8 a plate, and 3 a nail-plate combination. No differences were observed in AO/OTA fracture patterns between groups. Open reduction was performed in 35 cases and closed or percutaneous reduction in 30 cases. Closed reductions had significantly shorter surgery durations and decreased estimated blood loss (EBL) compared to open reductions (p = 0.028 and p = 0.049, respectively). Radiographically, maximal cortical displacement on lateral imaging was significantly increased in closed or percutaneously reduced fractures compared to open reductions (p = 0.025). IMN fixation was utilized in patients with higher BMI (p = 0.017). IMN fixation resulted in increased maximal cortical displacement on lateral imaging compared to plate and combination nail-plate fixations (p = 0.041). No differences in mRUST at multiple time points were observed in reduction method or implant type. Our average length of follow-up was 132 days. Post-operatively, no differences existed in pain, independent ambulation, complication or revision rates between implants or reduction methods.

Subtrochanteric fractures treated with open reduction and presence of a plate in the fixation can improve sagittal alignment. Closed/percutaneous reduction decreases surgery duration and estimated blood loss. Regardless of reduction type and implant, adequate reduction, high union rates and successful outcomes are possible. Anatomic reduction and stable fixation are essential in surgical treatment, regardless of approach or implant choice.