Objectives: Surgical treatment of comminuted subtrochanteric fractures may be associated with high incidences of nonunion and implant failure. Taking the advantages of biologic fixation may solve this problem by yielding rapid callus formation and thus butressing the medial cortex.

Patients and method: 21 patients with comminuted subtrochanteric femur fractures were operated. Mean age was 35.4 (13–60) years. There were 5 type IA, 9 type IB, 3 type IIA and 4 type IIB fractures according to Russel-Taylor classification. All patients were treated with indirect reduction and biologic internal fixation. Patients were clinically assessed for pain, muscle power, hip and knee range of motions, angular and rotational deformities and leg length discrepency at latest follow-up. Functional assements were done using the Traumatic Hip Rating Scale proposed by Sanders et al.

Results: Patients were followed for a mean of 26.3 (12–55) months. Union was achieved in all patients in a mean of 15.85 (13–22) weeks. Limb-length discrepecency was dedected in 7 patients. In these 7 patients the operated extremity was short by a mean of 1.28 (1–2) cms. There was no limping in any patients due to limb-length discrepecency. A rotational deformity of lesser than 10 degrees was present in 5 patients. A frontal plane (varus) malalingment lesser than 10 degrees was present in 3 patients. 10 degrees and 20 degrees of restriction in flexion was present in 2 patients. Functional results were excellent in 14 and good in 7 patients. No patient had poor functional result or failure. All patients were satisfied with their postoperative functional results. A superficial infection dedected in early postoperative period in one case and it was treated with local wound care and antibioteraphy. There were no signs of infection in this patient at latest follow-up. Deep infection did not develop in any patients. Delayed union or non-union was not present in any patients.

Conclusions: Indirect reduction and biological internal fixation yields satisfactory results in comminuted fractures. These results can be attributed to early weight bearing with rapid solid callus formation and early union. Rapid callus formation and early union with biologic fixation is particularly advantageous in comminuted subtrochanteric fractures as it avoids implant failure which is not uncommon in these fractures.