Subtrochanteric Femoral Fracture
Subtrochanteric femoral fractures are difficult fractures to manage. It is widely accepted that the most optimal way of fixing it is by an intra-medullary device. Whilst intra-medullary devices have certain advantages to the plates (locking plate, DHS, reverse LISS), the main disadvantage of the intra-medullary devices is the lack of reduction unless we open the fracture. And if the fracture is already open, we certainly lose the advantage of "intact fracture haematoma".
Simple question: "Is fracture haematoma more important than anatomical reduction in subtrochanteric fractures?"
Answer is not that simple but basic guidelines can be found on AO website. For more details ask uncle Google (i.e. absolute stability vs relative stability fracture) or better senior colleagues.
X-rays below present one of the typical examples of "subtrochanteric fracture fixation" using an intra-medullary device.
Simple question: "Is fracture haematoma more important than anatomical reduction in subtrochanteric fractures?"
Answer is not that simple but basic guidelines can be found on AO website. For more details ask uncle Google (i.e. absolute stability vs relative stability fracture) or better senior colleagues.
X-rays below present one of the typical examples of "subtrochanteric fracture fixation" using an intra-medullary device.
Fracture looks relatively "straight forward" on the initial X-ray. Intra-medullary fixation is certainly a good option. But is it really?
Looking through the intra-operative and post operative X-rays this fracture fixation stands relatively small chances to heal. Why? In my understanding Stress/Strain is the answer.
Please read Perren's article published in BJJ(formerly known as JBJS (Br). Does it make sense?
Looking through the intra-operative and post operative X-rays this fracture fixation stands relatively small chances to heal. Why? In my understanding Stress/Strain is the answer.
Please read Perren's article published in BJJ(formerly known as JBJS (Br). Does it make sense?
Few examples from my practice are below.
Subtrochanteric fracture....
Periprosthetic fracture....
Subtrochanteric Spiral fracture with butterfly segment....
Comminuted Subtrochanteric fracture....
As you can see from the cases above I will plate vast majority of subtrochanteric fractures. One of the reasons is that I have to open the fracture to reduce it. And when it is opened I just put a plate on it.
More important reason is that it has to be reduced, otherwise IT WILL NOT HEAL.
My conclusion for subrochanteric femoral fractures:
More important reason is that it has to be reduced, otherwise IT WILL NOT HEAL.
My conclusion for subrochanteric femoral fractures:
NO REDUCTION = NO HEALING
And I believe we all know what "NO HEALING" entitles. Not good.
