Abstract
The purpose of this study was to prospectively audit the functional outcome and peri-operative complications associated with the use of a trochantericentry cephalomedullary nail to treat all low-energy subtrochanteric fractures.
Methods: Over a 95 month period, we used the Long Gamma Nail (LGN) to treat a consecutive series of 302 locally-resident patients who sustained subtrochanteric fractures during low-energy trauma. We prospectively assessed the mortality, prevalence of complications and functional outcome during the first year post-injury. We used survivorship methodology to assess the rate of re-operations and implant revision during the first year after surgery.
Results: By one year, 74 patients had died, 10 were untraceable and 7 refused to participate in follow-up. The remaining 211 patients had evaluation of their functional outcome and post-operative complications during the first year post-injury.
The prognosis following an operatively-treated subtrochanteric fracture was similar to other proximal femoral fractures, with a one-year mortality of 24.5%, and an increased level of social dependence, increased use of walking aids and reduction in mobility amongst survivors.
Re-operation was required in 27 patients (8.9%), although only 18 patients required nail revision. On survivorship analysis, 96.8% of fractures had healed by six months post-injury, and only five patients had confirmed non-unions, which were successfully treated with autogenous bone grafting. Lag-screw mechanical failure and fractures distal to the nail were seen in twelve (4%) and five (1.7%) patients respectively; all of these fractures subsequently healed after further treatment. Deep sepsis occurred in only five (1.7%) patients.
Conclusions: Subtrochanteric fractures caused by low-energy trauma have similar prognosis to other proximal femoral fractures. Trochanteric-entry cephalomedullary nails are a versatile treatment option for these injuries, and are associated with an acceptable rate of peri-operative complications and favourable functional outcome.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
