Subtrochanteric Femur Fractures

Management of Subtrochanteric Proximal Femur Fractures: A Review of Recent Literature

“…Secondly, hospice patients with minimal discomfort may be treated nonoperatively. However, numerous benefits, such as improved mobility, decrease of pain, and improving the care provided by care givers by the definitive fixation, should be thoroughly discussed with all individuals involved in the medical decision-making process before proceeding with nonoperative management [ 14 ].…”

“…Despite some studies revealing moderately good results with fixed angle plating with nonunion rates of approximately 0-10% with times to union of approximately 5 months [ 2 , 24 ], more recent studies have found less appealing results [ 25 ]. These recent changes in outcomes, coupled with the high degree of difficulty in applying this fixed angle devices and decreased infection rates, higher union rates, and shorter operative times with intramedullary nailing, have led to decreased use in 95-degree fixed angle plates [ 14 , 25 ]. Another form of fixed angle plating includes proximal femoral locking plates ( Figure 6 ).…”

“…These systems have been shown to have better biomechanical properties than blade plate constructs. However recent studies have also shown poor results including high malunion/nonunion rates and subsequent reoperation rates close to 35% [ 14 , 26 ]. Finally 135-degree compression plates, commonly used for intertrochanteric hip fractures, have been shown to have failure of fixation upwards of 56% and therefore have been abandoned in the surgical treatment of ST femur fractures [ 21 ].…”

“…In addition to increased rates of nonunion, excessive varus and flexion of the proximal segment can cause detrimental changes to gait mechanics. In general, the typical failure will result in a varus deformity ( Figure 7 ) and these complications are typically treated with exchange intramedullary nailing or fixed angle plate constructs with or without bone grafting [ 14 ].…”

“…In terms of deep infections, they may be approached with surgical irrigation and debridement with antibiotics in an attempt to allow the fracture to heal prior to implant removal. However, should the patient be found to have a persistent infected nonunion, removal of the implant is needed followed by temporary fixation with an antibiotic intramedullary device followed by antibiotics until the infection has been effectively treated [ 14 ].…”