Clinical Outcomeof Subtrochanteric Fractures With Operative Treatment

Objective:By retrospective study of operative treatment of subtrochanteric femur fractures,wecompare the clinical outcome of Gamma3 intramedullary nailing and LISS plate as the internal fixation, and analyze efficacy of limited incision with cable cerclage, to supply more informationfor diagnosis and treatment of subtrochanteric fractures.Material and Method:Subtrochanteric fracture cases from February 2011 to February 2014 in our hospital were retrospectively studied. A total of 149 cases treated with Gamma 3 nail or LISS plate wereinvestigated, wherein76 cases with Gamma3 intramedullary nail treatment and 73 cases with inverted LISS plate treatment.The two groups were recorded demographic data, type of fracture, complications, clinical results and other relevant information. Postoperative follow-up included radiography and hip function score. General results of the operation and Harris Hip Score(HHS) were compared. 76 cases with intramedullary fixation were followed up for 6-24 months.11 cases with intramedullary fixation combing cable cercalage were studied retrospectively.Results:149 caseswere followed up,which weredivided into Gamma 3 nail group (I group) and inverted LISS plate fixation group (II group). Gamma3 group included 76 cases, wherein 40 males and 36 females; the mean age was 53.5 years (37 to 72 years). LISS group included 73 cases, wherein 38 males and 35 females; mean age was 56.4 years (40 to 76 years). General information between the two groups showed no significant difference (P> 0.05).Incision length of Gamma3 group was significantly less than LISS group. Operative time, blood loss and bone healing time of Gamma3 group was less than LISS group.The difference was statistically significant (P<0.05). There was no significant difference of Harris score between the two groups after 1 month and 6 months.On clinical outcome Gamma3 group was higher than LISS group, but the difference was not statistically significant.76 cases of subtrochanteric fractures treated with Intramedullary nailing were followed up for 6-24 months with one case of delayed bone healing. Remaining fractures healed well with the average healing time 4.5 months. According to Harris Hip Score, excellent in 65 cases, good in 8 cases, fair in 2 cases and poor in 1 case. The overall excellent to good rate was 96.05%.11 cases of the 76 Intramedullary nailing were treated with limited incision combining cerclage, wherein 7 males and 4 females.Mean age was 53.5 years (43-78 years old). According to Seinsheimer fracture classification,3 cases of type â…¢,5 cases of type IV and3 cases of type V. The group was followed up for 6 to 12 months and all fractures healed with the average healing time 4.5 months. According to Harris score, excellent in 10 cases, good in 1 case. The overall excellent to good rate was 100%.Conclusion:Subtrochanteric fractures treated with extramedullary or intramedullary fixation can achieve good clinical results.However, there are certain advantages of intramedullary fixation in operation time, incision length, bleeding volume. limitedincision combining cerclage auxiliary fixing is a reliable method. The reduction of fractures, the surgical technique of operation have important significanceon the clinical outcome.