Evaluation of the results of intramedullary nailing of subtrochanteric femur fractures using either open or closed technique: a prospective study

Abstract

Background: Subtrochanteric femur fractures constitute a difficult subset of proximal femoral injuries owing to the complex biomechanical stresses acting across the region. Although intramedullary nailing is the preferred fixation method, there remains controversy regarding whether open or closed reduction provides better clinical outcomes.

Methods: A prospective cohort study was conducted at Dr. RPGMC Tanda from 2022–2024 including 40 patients with subtrochanteric femur fractures. Patients were divided into two groups: open reduction internal fixation (ORIF) with intramedullary nail (n=18) and closed reduction internal fixation (CRIF) with intramedullary nail (n=22). Demographic, perioperative, and outcome parameters were analyzed. Functional outcome was assessed using the Merle d’Aubigné hip score. Statistical analysis was performed using SPSS v25.0; p<0.05 was considered significant.

Results: Mean age was 53.2±20.8 years. The mean operative time was significantly higher in the open group (124.2±24.9 min) than the closed group (94.6±9.8 min, p<0.001). Blood loss was greater in the open group (274.4±88.5 ml vs. 103.9±44.7 ml, p<0.001). Mean union time was 17.7±4.6 weeks in open versus 19.6±5.0 weeks in closed group (p=0.29). The open group demonstrated significantly higher Merle d’Aubigné scores at 18–42 weeks (p<0.05). Complication rates were similar between groups, with superficial infection noted in two open cases.

Conclusion: Both open and closed techniques of intramedullary nailing are effective for subtrochanteric fractures. Although open reduction entails longer surgery and higher blood loss, it allows better anatomical reduction and improved mid-term functional outcomes without increasing major complications.