Biologic Plating Versus Intramedullary Nailing for Comminuted Subtrochanteric Fractures in Young Adults: A Prospective, Randomized Study of 66 Cases

Abstract

With the enhanced fixation properties demonstrated in the present study, the DCS proved to be a feasible fixation device for comminuted subtrochanteric fractures in young patients. Our results indicated that intramedullary nailing by a RTRN revealed no advantages over biologic plating by a DCS for treatment of such fractures.

Contemporary Management of Subtrochanteric Fractures

“…The cephalomedullary nails, therefore, have been used with increasing frequency, although many experienced surgeons may continue to prefer the stability achieved with use of the angled blade plate. 16,45,59,60 …”

Subtrochanteric femur fractures treated with extramedullary or intramedullary fixation at tertiary care centre

“…Our 83% cases belonged to type II and type III of the Seinsheimer classification. Lee et al [11] focused more on comminuted subtrochanteric femur fracture with majority of patients in type IV and type V, however he also obtained no difference between the two methods of fixation. While Rahme and Harris [17] had equal distribution of cases in type III and type V and with a more elderly population having observed a revision rate of 28% in blade plate group and 3% in intramedullary nailing group.…”

“…Delayed union was defined as no sign of fracture healing at 24 weeks after initial operation. [11] Nonunion was defined as absence of bone union (3 cortices in two orthogonal views) 48 weeks after the initial operation. [11] Following parameters were evaluated in follow up:…”

“…Various authors have reported improper reduction with resultant mal-union or non-union after intramedullary nailing of comminuted fractures. [9][10][11] Meta-analysis by Parker et al [13] showed no significant difference between two fixation methods in over 3500 patients. The superiority or equality between the two fixation methods cannot be established due to dearth of literature on comparison of the two fixation methods.…”

“…[3] Incidences of implant failure and poor functional outcome following subtrochanteric fractures of femur are not uncommon. [1][2][3][4][5][6][7][8][9][10][11] Its management is difficult due to instability of fracture pattern with a tendency to varus collapse and the muscular forces acting on the fractured fragments resulting in shaft medialization. [12] Implant used for fixation of subtrochanteric fracture should provide necessary mechanical strength while maintaining functional mobility of the limb until bony union is achieved.…”