Subtrochanteric fractures of the femur

M. L. Shelton

Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. While the benefits of open reduction and internal fixation in decreasing morbidity and mortality have been well established, formidable operative complications have occurred when this fracture is treated like an intertrochanteric fracture. Improved results have been obtained by utilizing a fixation device that can control the intertrochanteric instability and that has sufficient strength to withstand deforming forces that may be present for up to a year while the fracture is uniting. Bone grafting has been found very useful in shortening the overall period of healing.