SUBTROCHANTERIC FRACTURE OF THE FEMUR. [PLAITING OR LOCKING INTRAMEDULLARY NAIL]

Abstract

Purpose of this study is to compare the two techniques, [sliding nail plate, or locking intramedullary nail type ã], and to estimate their results of the surgical treatment of the subtrochanteric fractures of the femur.

Material and methods. From the January 1999 till December 2002, 38 subtrochanteric fractures patients have been operated in our clinic. According to the classification of AO/ASIF 12 of them were type A, 18 were type B and 8 type C. 28 patients were female & 10 male, aged from 41 to 90 years (mean 85 years old). 22 of cases were followed up for at least 6 months up to 20 months. 5 of the patients died for reasons other than the fracture itself and its treatment. The remaining 11 cases failed to appear for a follow-up.

They were all surgically treated. In 8 cases we performed the 135 DHS nailing and in the 21 cases the 95 DCP nailing. In the remaining 9 fracture cases we performed intramedullary nail type ã nail. In some cases, (plaiting – surgery) we used allograft. There were no intrasurgical complications.

Two material breakages, [failure], occurred as post-surgical complication [95 DCP), the one was treated with locking intramedullary nail type ã, and the other with prosthetic replacement [ Thomson].

The patients started moving immediately, although they used partial wait bearing in a period of 3 days to 6 weeks, depending on the type of fracture and internal fixation. The operation lasted from 3/4h up to 2h and we transfused from 1 to 3 blood units (mean 2,5)..

Results were better with locking intramedullary nail, than with any type of plating, [biological advantages – less failure].

Conclusion. All subtrocanteric fractures should be treated by stable internal fixation. Our recent experience with the new undreamed AO nail, and its versatile proximal locking has been very favorable.