Comparison between Intramedullary and Plate Fixation for Subtrochanteric Fracture of the Femur

Ko, Han Suk; Kim, Byung Jik; Choo, Suk Kyu; Choi, Jae Sung

Abstract

Management of subtrochanteric fractures of the femur is difficult because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The subtrochanteric fracture is difficult for the accurate reduction and maintenance because many of these fractures are cmminuted from high velocity trauma and its proximal fragment is severely displaced by adjacent strong muscles pooling. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recomended for use in subtrochanteric fractures and their selection should be based on the individual fracture anatomy. In recent years, generally accepted two methods are intramedullary nailing and plate fixation. We have reviewed our experience using the intramedullary fixation on 14 cases of subtrochanteric femur fracture and compared the result with those of 14 cases of plate fixation. All the 28 cases were treated at the Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University in the period from March 1988 to March 1993. Intramedullary fixation were implanted with shorter operating time, smaller incisions, and less intraoperative bleeding. The intramedullary fixation group had a shorter covalescence and earlier full weight-bearing but no significant difference in fracture union rate with plate fixation group. We conclude that with careful surgical technique, the intramedullary fixation was a more suitable method for the treatment of the subtrochanteric femoral fractures.