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Implantology of Subtrochanteric Fractures

Handbook of Orthopaedic Trauma Implantology

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Abstract

Subtrochanteric fractures are a subtype of proximal femur fractures found between the lesser trochanter and 5 cm distal to it. Due to its muscle insertions, the subtrochanteric region of the femur is susceptible to several deforming stresses and is an area of high stress concentration. Due to the prevalence of cortical bone, the subtrochanteric area has a more fragile vascularization than the trans-trochanteric zone, making it more difficult to consolidate fractures. Implant-related problems and fracture non-union are found to be prevalent in proximal femur fractures with a high reoperation rate. The bimodal occurrence of subtrochanteric fracture in young and elderly patients poses a problem when selecting the optimal implant to restore function with the lowest risk of surgical and medical problems.

The undamaged medial and lateral cortex under the lesser trochanter offers a buffer to fracture impaction following fixation, hence preventing its collapse. The degree of comminution of the posteromedial cortex and osteoporotic bone increases the degree of instability. Increased comminution reduces axial loading support via cortical contact. A fracture is rendered unstable if any of these cortical areas is deficient.

Implant fixation aims to produce stable reduction and fixing of the fracture, allowing for rapid mobilization. The orthopaedic community continues to discuss the reasoning for the design of extramedullary fixation for subtrochanteric fractures of the femur. Subtrochanteric fractures have been treated using intramedullary devices (SHS, condylar blade plate, and proximal femoral locking plate) rather than extramedullary implants (SHS, condylar blade plate, and proximal femoral locking plate) over the last 25 years. This chapter discusses the reasons for and suggestions for implant changes, as well as the implant of choice currently in use.

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References

  1. de Toledo Lourenço PRB, Pires RES. Subtrochanteric fractures of the femur: update. Rev Bras Ortop. 2016;51(3):246–53. https://doi.org/10.1016/j.rboe.2016.03.001.

    Article  Google Scholar 

  2. Nordin M, Frankel VH. Basic biomechanics of the musculoskeletal system. 4th ed. Baltimore: Lippincott Williams & Wilkins, A Wolters Kluwer Business; 2012. p. 84–5. Google Scholar

    Google Scholar 

  3. Bedi A, Le Toan T. Subtrochanteric femur fractures. Orthop Clin North Am. 2004;35(4):473–83. PMID: 15363922

    Article  Google Scholar 

  4. Rizkalla M, Nimmons SJB, Jones AL. Classifications in brief: the Russell-Taylor classification of subtrochanteric hip fracture. Clin Orthop Relat Res. 2019;477(1):257–61. https://doi.org/10.1097/CORR.0000000000000505.

    Article  Google Scholar 

  5. Berkes MB, Schottel PC, Weldon M, Hansen DH, Achor TS. Ninety-five degree angled blade plate fixation of high-energy unstable proximal femur fractures results in high rates of union and minimal complications. J Orthop Trauma. 2019;33(7):335340. https://doi.org/10.1097/BOT.00000000000015059.

    Article  Google Scholar 

  6. Pugh WL. A self-adjusting nail-plate for fractures about the hip joint. J Bone Joint Surg Am. 1955;37(5):1085–109.

    Article  Google Scholar 

  7. Joglekar SB. Contemporary management of subtrochanteric fractures. Orthop Clin. 2015;46(1):21–35. https://doi.org/10.1016/j.ocl.2014.09.001. PMID: 25435032

    Article  Google Scholar 

  8. Pai C-H. Subtrochanteric femur fractures with greater trochanteric extension treated with a dynamic condylar screw. J Orthop Trauma. 1996;10(5):317–22. https://doi.org/10.1097/00005131-199607000-00005. PMID: 8814572

    Article  CAS  Google Scholar 

  9. Lunsjo K, Ceder L, Stigsson L, Hauggaard A. Two-way compression along the shaft and the neck of the femur with the medoff sliding plate: one-year follow-up of 108 intertrochanteric fractures. J Bone Joint Surg Br. 1996;78(3):387–90. https://doi.org/10.1302/0301-620X.78B3.0780387.

    Article  CAS  Google Scholar 

  10. Saini P, Kumar R, Shekhawat V, Joshi N, Bansal M, Kumar S. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate. Injury. 2013;44(2):226–31. https://doi.org/10.1016/j.injury.2012.10.037. PMID: 23200761

    Article  Google Scholar 

  11. Wirtz C, Abbassi F, Evangelopoulos DS, Kohl S, Siebenrock KA, Krüger A. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate. Injury. 2013;44(6):756. https://doi.org/10.1016/j.injury.2013.02.020. PMID: 23522837

    Article  Google Scholar 

  12. Garrison I, Domingue G, et al. Subtrochanteric femur fractures: a review of the current treatment. EFORT Open Rev. 2021;6(2):145–51. https://doi.org/10.1302/2058-5241.6.200048. PMID: 33828858

    Article  Google Scholar 

  13. Zickle RE. A new fixation device for subtrochanteric femoral fractures: an preliminary report. Clin Orthop. 1967;54:115. Lippincott-Raven Publishers

    Google Scholar 

  14. Steen Jensen J, Sonne-Holm S. Critical analysis of ender nailing in the treatment of trochanteric fractures. Acta Orthop Scand. 1980;51(1–6):817–25. https://doi.org/10.3109/17453678008990879.

    Article  Google Scholar 

  15. Halder SC. Gamma nail treatment for Peritrochanteric fractures. J Bone Joint Surg Br. 1992;74:340–4. https://doi.org/10.1302/0301-620X.74B3.1587873. PMID: 1587873

    Article  CAS  Google Scholar 

  16. Borens O, et al. Long gamma nail in the treatment of subtrochanteric fractures. Arch Orthop Trauma Surg. 2004;124(7):443. https://doi.org/10.1007/s00402-004-0711-4. PMID: 15243759

    Article  Google Scholar 

  17. Maa K-L, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a meta-analysis. Orthop Traumatol Surg Res. 2014;100(8):859–66. https://doi.org/10.1016/j.otsr.2014.07.023. PMID: 25453927

    Article  Google Scholar 

  18. Gadegone WM, Salphale YS. Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007;31(3):403–8. https://doi.org/10.1007/s00264-006-0170-3. PMID: 16823585

    Article  CAS  Google Scholar 

  19. Chen J, Zuo CH, et al. Comparison of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in the treatment of intertrochanteric fractures in the elderly. Beijing Da Xue Xue Bao Yi Xue Ban. 2019;51(2):283–7. https://doi.org/10.19723/j.issn.1671-167X.2019.02.016.

    Article  CAS  Google Scholar 

  20. Ruecker AH, Rupprecht M, Gruber M, et al. The effectiveness of an intramedullary nail with integrated cephalocervical screws and linear compression in the treatment of intertrochanteric fractures. J Orthop Trauma. 2009;23(1):22–30. https://doi.org/10.1097/BOT.0b013e31819211b2. PMID: 19104300

    Article  Google Scholar 

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Authors and Affiliations

  1. Iyer Orthopaedic Centre, Solapur, Maharashtra, India

    B. Shivashankar

  2. Professor of Orthopaedics, Chandrapur, Maharashtra, India

    Wasudeo Gadegone

Authors
  1. B. Shivashankar
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  2. Wasudeo Gadegone
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Correspondence to B. Shivashankar .

Editor information

Editors and Affiliations

  1. Orthopaedic Surgery, NH Narayana Superspeciality and Multispeciality Hospitals, Howrah, West Bengal, India

    Arindam Banerjee

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Section Editor information

  1. Columbia Asia Hospital, Kolkata, West Bengal, India

    Saumitra Misra

  2. Columbia Asia Hospital, Kolkata, West Bengal, India

    Rajiv Chatterjee

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Shivashankar, B., Gadegone, W. (2023). Implantology of Subtrochanteric Fractures. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-15-6278-5_112-1

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  • DOI: https://doi.org/10.1007/978-981-15-6278-5_112-1

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-6278-5

  • Online ISBN: 978-981-15-6278-5

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  1. Latest

    Implantology of Subtrochanteric Fractures
    Published:
    01 July 2023

    DOI: https://doi.org/10.1007/978-981-15-6278-5_112-2

  2. Original

    Implantology of Subtrochanteric Fractures
    Published:
    09 February 2023

    DOI: https://doi.org/10.1007/978-981-15-6278-5_112-1

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