Subtrochanteric Fractures of The Femur: May a Short Nail Be a Reliable Option?

Objectives: Treatment of subtrochanteric fractures of the proximal femur may be challenging due to their anatomical and biomechanical features. Intramedullary nails are the most frequently used devices, although there is no consensus concerning their optimal length. The aim of this study is to compare the functional and radiological outcomes of the fragility subtrochanteric fractures treated with short versus long cephalomedullary nails.

Methods: A retrospective cohort study was performed including all over-65-year-old patients that underwent surgery with a cephalomedullary nail between January 2013 to December 2020 due to a subtrochanteric fracture. The primary outcome was the presence of mechanical complications (cut out, cut in, varus consolidation, nonunion and nail breakage). Accuracy of the reduction, distance from the fracture line to most proximal distal screw, operative time and Palmer Mobility score were also analyzed.

Results: Ninety-five patients were included. There were not significant differences in complication rate, Parker mobility score nor quality of reduction between both cohorts. Patients with a good radiological reduction presented no complications, those with an acceptable reduction presented a complication rate of 35.5% and it raised to 53.3% in poorly reduced ones (P=0.002). The complication rate was higher in the <5cm distance group (58.33%) than in the >5cm distance group (22.64%) (P=0.014).

Conclusion: Anatomical reduction may be the key factor in the management of subtrochanteric fractures, in order to avoid complications. The chosen device working length should also be taken into account to treat these challenging injuries.