Abstract
PurposeThe aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union.MethodsAll consecutive patients with a fracture involving the subtrochanteric region were retrospectively identified, over an 8-year period. Data documented and analysed included patient demographics, fracture characteristics, patient comorbidities, time to fracture union and development of complications.ResultsA total of 512 patients met the inclusion criteria (523 fractures). Open reduction was performed in 48% (247) of the fractures. Following matching and regression analysis, we identified diaphyseal extension of the fracture to be associated with an open reduction (OR: 2.30; 95% CI 1.45–3.65; p < 0.001). Open reduction was also associated with an increased risk of superficial infection (OR: 7.88; 95% CI 1.63–38.16; p = 0.010), transfusion within 48 h following surgery (OR: 2.44; 95% CI 1.96–4.87; p < 0.001) and a prolonged surgical time (OR: 3.09; 95% CI 1.96–4.87; p < 0.001). The risk of non-union, deep infection and overall mortality was not increased with open reduction. The use of cerclage wires [50 out of 201 fractures (24.9%) treated with an open reduction] to achieve anatomical reduction as compared to open reduction alone significantly reduced the risk of non-union (OR: 0.20; 95% CI 0.06–0.74; p = 0.015).ConclusionOpen reduction of subtrochanteric fractures is not associated with an increased risk of deep infection and non-union, even though it is associated with an increased risk of superficial infection, prolonged surgical time and transfusion. The use of cerclage wire is associated with reduced risk of non-union with little evidence of an increase in complications.Level of evidenceIII.
Highlights
Subtrochanteric fractures are defined as those encountered between the inferior border of lesser trochanter and 5 cm distal to it [1]
Even though our study has demonstrated no difference in the non-union rates between subtrochanteric fractures treated with closed or open reduction, we did identify that open anatomical reduction achieved by cerclage wire/cable to have a lower non-union rate (OR: 0.20), when compared to ‘clamp assisted only’ open reduction
With no exclusion criteria posed upon age or comorbidity, our study provides a better overview of the overall fracture demographics and epidemiology of subtrochanteric femur fractures encountered in a Level 1 Trauma Centre serving a metropolitan population
Summary
Subtrochanteric fractures are defined as those encountered between the inferior border of lesser trochanter and 5 cm distal to it [1]. They generally account for 5–34% of all proximal femoral fractures [2,3,4], and the ‘gold standard’ of their treatment is intramedullary (IM) nailing. There appears to be lack of strong evidence comparing the outcomes of open versus closed reduction in the management of subtrochanteric femoral fractures treated with cephalomedullary nailing
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