Analysis of Factors Affecting the Union of Closed Subtrochanteric Femur Fractures treated by Cephalomedullary Nailing
- Author:
Aroor MN
;
Kulkarni MS
;
Shetty S
;
Vijayan S
;
Bharadwaj SG
;
Rao SK
- Publication Type:Journal Article
- Keywords:
hip fractures;
subtrochanteric fractures;
cephalomedullary nailing;
malalignment;
fracture non-union
- From:Malaysian Orthopaedic Journal
2026;20(No. 1):28-
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: With surgical advancements and improved
implants and instrumentation, nailing is the procedure of
choice in subtrochanteric fractures. However, failure in
achieving reduction of the multidirectional displacement of
the fragments prior to passing the nail, contributes to
delayed/non-unions at the fracture site leading to implant
failures. In this study, we aim to analyse the factors affecting
union of closed subtrochanteric fractures treated by nailing.
Materials and methods: In this retrospective study, closed
subtrochanteric fractures treated with cephalomedullary
nailing between 2015 and 2019 were included.
Demographic, surgical and radiological data were retrieved
and analysed. A total of 60 cases were eligible to be included
in the study.
Results: Majority of patients were male (50), with a mean
age of 46.07±16.40 years. Twenty-two fractures were
multifragmentary having a separate butterfly fragment. In 27
patients mini-open technique was used to get the anatomical
alignment and to hold reduction until fixation. Overall, the
mean time for union was 7.63±5.85 months. We had nine
delayed unions and eight non-unions. Varus alignment in the
coronal plane of more than 8.5° was the only significant
factor associated with delayed or non-union apart from loss
of medial continuity.
Conclusion: We recommend achieving fracture reduction
with less than 8.5° of varus malalignment in the coronal
plane. Varus malalignment is poorly tolerated in fractures at
this region. To achieve this, we suggest having a very low
threshold to minimally open the fracture site for reduction of
these fractures, which does not have any negative effect on
the fracture union.
- Full text:2026030910460102785subtrochanteric-femur-fractures.pdf
