A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level

Abstract

The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a gamma nail were retrospectively analyzed. A 95 degrees angular blade plate was used in 107 cases, a dynamic condylar screw in 25, and a gamma nail in 29. There were 114 patients who were admitted after a simple fall and 47 who had sustained a high-energy trauma. In the type of trauma, associated lesions, ISS, pre-existing diseases and finally age we found statistically significant difference (P < 0.001) between patients admitted after a simple fall and patients admitted after a high-energy trauma. The mean operating times for the 95 degrees angled blade plate, the dynamic condylar screw and the gamma nail were 86, 85 and 74 min, respectively. Of the 161 patients, 18 required a revision operation. Of these 18 patients, 8 were initially treated using a 95 degrees condylar blade plate, 2 with a dynamic condylar screw and finally 8 with insertion of a gamma nail; 5 of these patients were less than 70 years old, while the other 13 were older than 70 years (P = 0.025; Fisher's exact test P = 0.042). The post-injury roentgenogram showed a fracture at the level of the lesser trochanter in 11 of the patients older than 50 years (P = 0.017; Fisher exact P = 0.053). Among the 18 patients who underwent revision operations, the post-injury roentgenograms showed 6 type IIIA fractures and 5 type V fractures.(ABSTRACT TRUNCATED AT 250 WORDS)