Published: 2020-04-22

Study of management of subtrochanteric fractures of femur with reconstruction nail

Shivananda Sundaram, Lokesh Munaiah, Radhakrishna A. Mallegowda, Jayaram B. Siddegowda, Jai Aditya Jhamb


Background: Subtrochanteric fractures of femur are the fractures occurring from the inferior aspect of the lesser trochanter to 5 cm distally. They represent a challenge for surgeons due to the deforming forces acting on the region and the high rates of complications like non-union. This study evaluates the fixation of subtrochanteric fractures of femur with reconstruction nail which is a specialized antegrade intramedullary nail for femur.

Methods: A prospective study conducted between October 2017 to May 2019 where 20 cases of subtrochanteric fractures of femur were treated with reconstruction nail and were followed up serially till 24 weeks radiologically and clinically.

Results: The average time of union for patients was 5.15±1.14 months with 3 patients whose fractures didn’t unite where one went for frank non union, one had a refracture and one patient had reverse z effect. The functional outcome was excellent in 45% patients and good in 30% patients while poor in 3 (15%) patients.

Conclusions: Reconstruction nail is a good device for subtrochanteric fractures of femur providing rigid fixation with low complication rates.


Subtrochanteric fracture of femur, Reconstruction nailing, Modified Harris hip score

Full Text:



Raj DV, Arokiaraj MB, Xavier AA. Functional and radiological outcome of subtrochanteric fracture treated with proximal femoral nail. Int J Orthop Sci. 2018;4(1):816-9.

Patidar V, Mishra PK, Choudhary R. Subtrochanteric femoral fracture and dynamic condylar screw- institutional study. Int J Orthop Traumatol Surgical Sci. 2018;(1):46-51.

Mirbolook A, Siavashi B, Jafarinezhad AE, Khajeh Jahromi S, Farahmand M, Roohi Rad M, et al. Subtrochanteric Fractures: Comparison of Proximal Femur Locking Plate and Intramedullary Locking Nail Fixation Outcome. Indian J Surg. 2015;77:795-8.

Patel R, Menon H, Chaudhari N, Chaudhari V. Subtrochanteric femur fractures treated with extramedullary or intramedullary fixation at tertiary care centre. Int J Med Sci Public Heal. 2016;6(2):1.

Hak DJ, Wu H, Dou C, Mauffrey C, Stahel PF. Challenges in Subtrochanteric Femur Fracture Management. Orthopedics. 2015;38(8):498-502.

Chakraborty M, Thapa P. Fixation of subtrochanteric fracture of the femur: Our experience. J Clin Diagnostic Res. 2012;6(1):76-80.

Medda S, Pilson H. Subtrochanteric Femur Fractures. Available at: NBK507803/. Accessed on 3 June 2019.

Vaishya R, Agarwal AK, Gupta N, Vijay V. Reversed distal femoral locking plate for failed proximal femoral nail with non-union of proximal femoral fractures. Int Orthop. 2016;40(8):1709-15.

Nageswaran J, Loganathan S, Ram G, Sumesh S, Chittaranjan S. Role of proximal femur locking plate fixation in certain unstable trochanteric fractures. Int J Res Med Sci. 2015;3(10):2815-9.

Yoon RS, Donegan DJ, Liporace FA. Reducing Subtrochanteric Femur Fractures. J Orthop Trauma. 2015;29(4):28-33.

Wiss DA. Master of techniques in orthopaedic surgery. 2nd Edition. Lippincott Willaims & Wilkins; 2006.

Donegan DJ, Anari JB, Yoon R, Liporace FA. Subtrochanteric Femur Fractures: Optimal Incision Location for Clamp-assistant Intramedullary Nailing. University of Pennsylvania Orthopaedic Journal. 2015;25:12-15.

Campbell’s Textbook of Orthopedics. 13th edition Part XV, Fractures and dislocations in adults. Page 2840, 2018.

Gao M, Zhu R, Shi W, Yang H. A comparative study of long third-generation gamma nail and long proximal femoral nail antirotation in the treatment of subtrochanteric femoral fracture. Int J Clin Exp Med. 2017;10(12):16425-34.

Shah A, Shah M. Functional outcomes of subtrochanteric femur fractures treated by intramedullary proximal femur nail. Int J Orthop Sci. 2017;3(2):876-81.

Kang SH, Han SK, Kim YS, Kim MJ. Treatment of subtrochanteric nonunion of the femur: Whether to leave or to exchange the previous hardware. Acta Orthop Traumatol Turc. 2013;47(2):91-5.

Ahmad S, Singh R, Ghani A, Muzaffar K, Singh O. Management of Subtrochanteric Fractures with Long PFN: Union Rates and Functional Results. Int J Curr Res Rev. 2017;9(9):14-9.

Choi JY, Sung YB, Yoo JH, Chung SJ. Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices. Hip Pelvis. 2014;26(2):107-14.