Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails.

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.