Abstract
Introduction
Debate still exists as to the optimum method of fixation for subtrochanteric femoral fractures. Meta-analysis of studies comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures have suggested that further investigation is required in this area. We present the outcome of the largest series to date of subtrochanteric fractures treated by both methods and with a minimum of one year follow-up.
Methods
244 patients with a subtrochanteric femur fracture were treated at one centre over a 21 year period were prospectively studied. 75 were treated with an extramedullary fixation implant and 168 with an intramedullary nail. Surviving patients were followed up till one year from injury.
Results
The mean age of patients was 74 and 71% were female. Fixation failure requiring revision surgery occurred in 4% of those treated with an extramedullary implant and 6% of those treated with an intramedullary nail, a difference that was not statistically significant. Length of surgery was similar for both operations but transfusion requirements were less for those treated by the intramedullary nail (p<0.0001). No notable differences in other outcomes were found.
Discussion
In summary both intramedullary and extramedullary fixation produce comparable outcomes for this fracture.
