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Updated: Sep 10, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Comparing the Outcomes of Intramedullary Nail Fixation for Subtrochanteric Femur Fractures Performed by Trauma
Stephen M Himmelberg1, Nathaniel T Koutlas2, Abigail E Smith2
1Orthopedic Surgery, University of North Carolina Hospitals, Chapel Hill, USA.
Introduction:
Reduction of subtrochanteric femur fractures can be challenging due to the strong deforming forces at the hip. Increased experience with trauma fellowship training may potentially result in better outcomes, but subspecialty-trained surgeons may not be available for each case.
Purpose:
The goal of this study was to compare postoperative complication rates, radiographic outcomes, and union rates among trauma fellowship-trained and non-trauma-trained orthopaedists following intramedullary nail fixation (IMN) of subtrochanteric femur fractures.
Methods:
All patients with a subtrochanteric femur fracture treated at an academic Level 1 trauma center between 2010 and 2020 were identified. One hundred and thirty patients met the inclusion criteria and had a minimum follow-up of three months. Medical records were reviewed for demographic data, comorbidities, and associated injuries. Intraoperative variables, including implant, positioning, and the need for open reduction, were collected. Complications, including nonunion, surgical site infection (SSI), and reoperation, were compared between the two cohorts.
Results:
Seventy-one patients were treated by trauma surgeons, while 59 patients were treated by non-trauma surgeons. Patients treated by trauma surgeons were more likely to be younger (58.1 vs 67.5, p = 0.01) and male (60.6% vs 44.1%, p = 0.06). Initial Injury Severity Score was similar (14.2 vs 13.1, p = 0.51). Open reduction was performed more frequently by non-trauma surgeons (18.3% vs 44.1%, p < 0.0014). The overall union rate was not statistically different (96% vs 90.3%, p = 0.36), while there was a trend toward malunion and malreduction in the non-trauma-trained cohort; these differences were not statistically significant (19% vs 6%, p=.092; 20% vs 10%, p=0.079). Reoperation rates (11.3% vs 8.5%, p=0.59), SSI (2.8% vs 5.1%, p=0.50), and readmission rates (2.8% vs 8.5%, p=0.15) were not statistically different.
Conclusion:
Union rates were similar between surgeons with and without trauma fellowship training after intramedullary nailing of subtrochanteric femur fractures. Further prospective studies are required to remove any inherent bias related to injury complexity.
