Subtrochanteric fractures of the femur: a review of 130 patients.

A review of 130 patients with subtrochanteric fractures of the femur has led to a new classification based upon fracture pattern. Type I is a short oblique, Type II a long oblique, and Type III any comminuted fracture of the subtrochanteric area. Twenty-two patients were treated with traction and 108 patients treated by surgical operation. Stable fractures treated in skin traction did well and extensively comminuted fractures appeared to be best treated with 90-90 skeletal traction. In the Type I and Type II fractures, it was determined that these fracture patterns were stable and any strong nail-plate device will provide adequate fixation. The Type III fracture may be converted to Type I or Type II by lag screw fixation and then fixed accordingly but if stability cannot be obtained by this method, a sliding screw type of device appeared to offer the best fixation. Supplementary bone graft where necessary to restore the medial buttress offered singularly better healing. Delayed weight bearing until fracture healing was secure gave the best chance of primary bone healing without deformity.