Contemporary management of subtrochanteric fractures

• Published in: The Orthopedic clinics of North America Vol. 46; no. 1; p. 21
• Main Authors: Joglekar, Siddharth B, Lindvall, Eric M, Martirosian, Armen
• Format: Journal Article
• Language: English
• Published: United States 01.01.2015
• Subjects: Femoral Neck Fractures - diagnosis; Femoral Neck Fractures - etiology; Femoral Neck Fractures - surgery; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Internal Fixators; Angled blade plate; Reconstruction nail; Trochanteric entry; Subtrochanteric fracture; Cephalomedullary nails
• ISSN: 1558-1373
• DOI: 10.1016/j.ocl.2014.09.001

Cephalomedullary interlocking nails that allow for trochanteric entry and minimally invasive fixation have revolutionized the contemporary management of subtrochanteric fractures with improved union rates and decreased incidence of fixation failure. The most successful alternative to intramedullary fixation remains the angled blade plate. Despite biomechanical superiority of contemporary intramedullary implants to previous intramedullary devices, the importance of achieving and maintaining satisfactory fracture reduction prior to and during hardware insertion cannot be overemphasized. In comminuted and more challenging fractures, additional techniques, such as limited open reduction with clamps and/or cables, can allow for canal restoration and more anatomic reductions prior to and/or during nail insertion.