Comparison of Intramedullary and Extramedullary Fixation Results in Subtrochanteric Femur Fractures.

Abstract

The subtrochanteric femur is a load-bearing region where deforming forces are effective. These fractures are difficult to treat for orthopedic surgeons. In this article, we aimed to compare intramedullary (IM) and extramedullary (EM) fixation methods for these fractures that do not have gold standard treatment. Eighty-five patients were retrospectively evaluated. Patients with IM implants (IM femoral nail, proximal femoral nail) were grouped as Group 1, and patients with EM implants were grouped as Group 2 (95° condylar plate, locked anatomical proximal femoral plate). Patients' age, gender, fractured hip side, etiology, anesthesia type, preoperative waiting time, follow-up period, fracture type, Harris hip score (HHS), and mechanical complications were examined. The mean age of the patients was 44.13 years. There was no difference between the groups in terms of age and gender. The mean follow-up period of the patients was 13.28 months. Falling from a height was the most common cause of subtrochanteric fracture. IM fixation was applied to 62 patients, and EM fixation was applied to 23 patients. No significant difference was found between Groups 1 and 2 in non-union, delayed union, implant failure, shortness rates, and HHS. Both IM and EM fixation methods have advantages and disadvantages in treating subtrochanteric fractures. These methods yield similar results in both groups in our study. The issue of fixation methods remains controversial in the literature, and further studies are needed on this subject.