Outcomes Of Subtrochanteric Fractures:A Retrospective Comparative Study Between Intramedullary Nail And Plate

BackgroundSubtrochanteric fractures are among the most challenging injuries in the proximal femur due to the complex muscular and bony anatomy of the femur in the region.They tend to have bimodal age characteristics,with injuries affecting the young usually result from high energy trauma and elder fractures occur from simple falls because of their osteoporotic fragile bones.Although advances have been made in the surgical management of these injuries,but the choice of implant is still on debate and the morbidities associated with surgery remain considerably high.ObjectivesThe main objective of this study is to evaluate the complication rates and assess Intraoperative and postoperative outcomes of two groups of surgically treated adult subtrochanteric fracture patients.One group managed with intramedullary nail and the other plating.MethodsClinical and radiographic data of 42 subtrochanteric fracture patients treated either with intramedullary nail or plate at our hospital between September 1999 and October 2017 were retrospectively reviewed and collected for analysis.The mean age was 54.86 years-old.33 patients were fixed with nail and 9 with open reduction and internal fixation with plate.Complication rates,duration of hospital stay,incision length as well as other preoperative,intraoperative and postoperative characteristics were assessed to determine any difference between the two groups.ResultsForty two cases were evaluated in the final analysis(33 in the nail group and 9 in the plate group).The two groups were similar regarding their age,sex,mechanism of injury,injured side,fracture pattern and associated injuries.Patients in the nail group demonstrated a shorter hospitalstay(P= 0.011)and smaller incision length(P < 0.001).The complication rate was not significantly different between the two groups(P =0.387);but there was tendency that plating had higher complication rates(1 of 9;11.1%)than the nail group(1 of 33;3%).ConclusionSubtrochanteric adult fractures can be surgically fixed with either intramedullary nail or plate.Although our study could not detect a significant statistical difference in complication rates between nailing and plating,a longer hospital stay was observed in the plate group.