Published: 2021-10-26

A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

S. F. Kammar, Karthik B., V. K. Bhasme, Suryakanth Kalluraya


Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.

Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.

Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.

Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.


Subtrochanteric fractures, Proximal femoral nail, Road traffic accidents

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Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am. 2004;35(4):473-83.

Ekström W, Németh G, Samnegård E, Dalen N, Tidermark J. Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 2009;40:371-6.

Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res. 2014;472:2728-34.

Zhou ZB, Chen S, Gao YS, Sun YQ, Zhang CQ, Jiang Y. Subtrochanteric femur fracture treated by intramedullary fixation. Chin J Traumatol. 2015;18(6):336-41.

Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia: Lippincott Williams and Wilkins Inc. 2006;1827-44.

Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF; Evidance-Based Orthopaedic Trauma Working Group. Unstable pertrochanteric femoral fractures. J Orthop Trauma. 2005;19(1):63-6.

Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ .Classification of subtrochanteric femoral fractures. Injury. 2010;41:739-45.

Beingessner DM, Scolaro JA, Orec RJ, Nork SE, Barei DP .Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: a retrospective study of 56 cases. Injury. 2013;44:1910-5.

Bergman GD, Winquist RA, Mayo KA, Hansen ST. Subtrochanteric fracture of the femur: Fixation using a Zickel nail. J Bone Joint Surg. 1987;69A:1032-40.

Tyllianakis M, Panagopoulos A, Papasimos S, Mousafiris K. Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patients. Acta Orthop Belg. 2004;70(5):444-54.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechening W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up 15 months. Acta Orthop Scand. 2003;74(1):53-8.

Chung PH, Kang S, Kim JP, Kim YS, Lee HM, Huh DJ. Treatment of unstable pertrochanteric fractures with a long intramedullary nail. Hip Pelvis. 2013;25:51-6.

Perren SM, Fernandez Dell'Oca A, Lenz M. Cerclage, evolution and potential of a Cinderella technology. An overview with reference to periprosthetic fractures. Acta Chir Orthop Traumatol Cech. 2011;78:190-9.

Abraham VT, Chandrasekaran M, Mahapatra S. Outcome of subtrochanteric fracture of the femur managed with proximal femoral nail. Int Surg J. 2016;3(3):1296-300.

Jiang LS, Shen L, Dai LY. Intramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results. Ann Acad Med Singapore. 2007;36(10):821-6.

Muller T, Topp T, Kuhne CA. The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop. 2011;35:1237-43.

Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN. Unfallchirurg. 2002;105(10):881-5.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechening W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up 15 months. Acta Orthop Scand. 2003;74(1):53-8.

Simmermacher RKJ, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327-32.

Kennedy MT, Mitra A, Hierlihy TG. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury. 2011;42(11):1317-21.

Borens O, Wettstein M, Kombot C, Chevalley F, Mouhsine E, Garofalo R. Long gamma nail in the treatment of subtrochanteric fractures. Arch Orthop Trauma Surg. 2004;124:443-7.

El-Mowafi HM, Eid TA, El-Sayed AS, Zalalo SH. Fixation of subtrochanteric fracture femur using a proximal femoral nail. Menoufia Med J. 2014;27:208-14.