- •Internal fixation with intramedullary nails is a common method for the treatment of subtrochanteric fracture.
- •To our knowledge, no study has compared and analyzed the clinical and radiologic outcomes of these nails in elderly patients aged ≥65 years.
- •A prospective case-matched study was done on patients ≥ 65 years with femoral subtrochanteric fracture and underwent intramedullary nailing.
- •Differences in all results were not statistically significant; however, the RCN group tended better reduction quality than the CMN group.
- •RCN has outstanding reduction quality, strong fixation, and excellent clinical/radiologic outcomes for femoral subtrochanteric fractures.
Intramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients.
Materials and methods
This retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined.
The difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné–Postel score. No significant differences were found for any of the parameters.
In the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Injury
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Subtrochanteric femur fractures: current review of management.EFORT Open Rev. 2021; 6: 145-151
- Subtrochanteric fractures: issues and challenges.Injury. 2017; 48: 2023-2026
- Subtrochanteric fractures of the femur.Injury. 1997; 28: 91-95
- Contemporary management of subtrochanteric fractures.Orthop Clin North Am. 2015; 46: 21-35
- Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients.Injury. 2009; 40: 371-376
- A comparison between Asians and Caucasians in the dimensions of the femoral isthmus based on a 3D-CT analysis of 1189 adult femurs.Eur J Trauma Emerg Surg. 2021; (Online ahead of print)
- The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy.Bone. 2016; 85: 142-147
- Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis.Clin Interv Aging. 2015; 10: 803-811
- Biomechanical characteristics and surgical management of subtrochanteric fractures.Orthop Clin North Am. 1974; 5: 629-650
- Reducing subtrochanteric femur fractures: tips and tricks, do's and don'ts.J Orthop Trauma. 2015; 29 (Suppl 4): S28-S33
- Intramedullary versus extramedullary fixation in the treatment of subtrochanteric femur fractures: a comprehensive systematic review and meta-analysis.Acta Orthop Traumatol Turc. 2020; 54: 639-646
- Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture.Orthopedics. 2012; 35: e41-e47
- Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion.J Orthop Trauma. 2002; 16: 231-238
- Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails.Injury. 2007; 38: 1286-1293
- A study of 44 patients with subtrochanteric fractures treated using long nail and cerclage cables.Musculoskelet Surg. 2015; 99: 225-230
- Patterns of bone mineral density testing: current guidelines, testing rates, and interventions.J Gen Intern Med. 2004; 19: 783-790
- Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research.J Bone Miner Res. 2014; 29: 1-23
- Poller (blocking) screw with intramedullary femoral nailing for subtrochanteric femoral non-unions: clinical outcome and review of concepts.Eur J Trauma Emerg Surg. 2021;
- New classification system for long-bone fractures supplementing the AO/OTA classification.Orthopedics. 2012; 35: e709-e719
- Correction of malalignment in proximal femoral nailing–Reduction technique of displaced proximal fragment.Injury. 2010; 41: 634-638
- Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks.Int Orthop. 2020; 44: 645-653
- Intramedullary nailing of the femur: current concepts concerning reaming.J Orthop Trauma. 2009; 23: S12-S17
- A forward-striking technique for reducing fracture gaps during intramedullary nailing: A technical note with clinical results.Injury. 2015; 46: 2507-2511
- Exchange nailing for hypertrophic femoral nonunion.J Orthop Trauma. 2017; 31: S23-S25
- Angular malalignment after intramedullary nailing of femoral shaft fractures.J Orthop Trauma. 2001; 15: 90-95
- Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw.BMC Musculoskelet Disord. 2018; 19: 448
- Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures.Injury. 2020; 51: 400-406
- The stability score of the intramedullary nailed intertrochanteric fractures: stability of nailed fracture and postoperative patient mobilization.Clin Orthop Surg. 2013; 5: 10-18
- Nonunion of fractures of the subtrochanteric region of the femur.Clin Orthop Relat Res. 2004; : 185-188
- Treatment of subtrochanteric nonunions.Injury. 2006; 37: 203-211
- Effects of ethnicity on proximal femoral intramedullary nail protrusion-a 3D computer graphical analysis.Arch Orthop Trauma Surg. 2021; 141: 845-853
- Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation.Injury. 2006; 37: 984-989
- Long gamma nail in the treatment of subtrochanteric fractures.Arch Orthop Trauma Surg. 2004; 124: 443-447
- The long gamma nail in the treatment of 329 subtrochanteric fractures with major extension into the femoral shaft.Eur J Surg. 2000; 166: 240-246
- Fixation of segmental subtrochanteric fractures: a biomechanical study.Clin Orthop. 1996; 332: 71-79
- Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients.J Orthop Surg (Hong Kong). 2013; 21: 308-312
- Reverse oblique and transverse intertrochanteric femoral fractures treated with the long cephalomedullary nail.J Orthop Trauma. 2015; 29: e299-e304
- Subtrochanteric femoral fractures.J Am Acad Orthop Surg. 2007; 15: 663-671
- A biomechanical comparison of two intramedullary implants for subtrochanteric fracture in two healing stages: A finite element analysis.Appl Bionics Biomech. 2015; 2015475261
- Current understanding of epidemiology, pathophysiology, and management of atypical femur fractures.Curr Osteoporos Rep. 2018; 16: 519-529
- Evaluation and management of atypical femoral fractures: an update of current knowledge.Eur J Orthop Surg Traumatol. 2021; 31: 825-840
- Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails.Clin Orthop Relat Res. 2014; 472: 2728-2734
- Surgical management of atypical femur fractures associated with bisphosphonate therapy.J Am Acad Orthop Surg. 2018; 26: 864-871
- The importance of reconstruction nailing for diaphyseal atypical femoral fractures: a comparative study with standard nailing.Arch Orthop Trauma Surg. 2021; (Online ahead of print)
Published online: January 24, 2022
Accepted: January 23, 2022
© 2022 Elsevier Ltd. All rights reserved.