Subtrochanteric Femur Fractures: How to Avoid Pitfalls

Subtrochanteric femur fractures pose unique challenges because of strong deforming muscular forces and high biomechanical stresses at the proximal femur, leading to a high rate of complications. It is important to review common pitfalls in the treatment of subtrochanteric fractures and provide strategies to avoid them. Key pitfalls include delayed surgical treatment, difficulties with patient positioning (especially in patients with obesity), malreduction in varus or flexion, improper intramedullary nail entry point, unrecognized limb rotation or length discrepancies, and inadequate fixation. For each pitfall, the cause, methods of prevention, and management strategies must be identified. Recognizing and addressing these pitfalls is important for obtaining optimal outcomes. By understanding these potential problems and their solutions, orthopaedic surgeons can minimize predictable complications, including malunion, nonunion, or failure of fixation, and improve healing of these challenging fractures.