Introduction and Aims: Subtrochanteric femoral fractures are associated with high rates of non-union and implant failure, regardless of the method of fixation. This study aims to compare closed intra-medullary nailing without anatomic reduction to open reduction and internal fixation using a fixed angle device, for subtrochanteric femur fractures.

Method: All skeletally mature patients admitted to two metropolitan trauma centres with subtrochanteric femur fractures were included in this study. Patients were randomised to intra-medullary nailing (IM) or internal fixation with a 95-degree blade plate (BP). Randomisation was concealed. The IM group were treated by closed insertion of a proximal femoral nail without anatomic reduction. The BP group were treated with open anatomic reduction and rigid fixation using a 95-degree angled blade plate. Bone grafting was at the discretion of the operating surgeon. All patients were mobilised non weight bearing for 12 weeks or until callus was seen on radiographs.

Results: A total of 41 patients (20 IM and 21 BP) with a minimum follow-up of six months have been included. There was no significant difference between the two treatment groups with regard to age, time to surgery, length of procedure, blood transfusion requirements, length of stay, or fracture classification (Seinsheimer). The fixation failure rate was 29% (six patients) in the BP group. There were no fixation failures in the IM group. The difference is statistically significant (p< 0.05). An increased infection and mortality rate was noted in the IM group, although it was not statistically significant.

Conclusion: Internal fixation of subtrochanteric femur fractures with a 95-degree angled blade plate is associated with increased implant failure and revision compared to closed intra-medullary nailing using a proximal femoral nail.