Analysis of treatment problems in subtraochanteric fractures of the femur.

In a retrospective study of 82 subtrochanteric fractures of the femur in the St. Paul-Ramsey Hospital, there were 32 treated by traction, 50 by open reduction and internal fixation. In adults 50% of those treated by traction had undesirable results using strict criteria for varus, shortening, and rotational deformity: 21% of those treated by operation had undesirable results due to varus, rotational deformity, medial migration of the distal fragment, and nonunion. Good resutls are related to stable reduction and individualization of a particular implant based on the fracture pattern, including reconstruction of the medial cortical wall, and close contact of the fracture fragments during healing. If reduction is not achievable, bone grafting and extra protection are required. If reduction can be predicted as not achievable, good results can be obtained with traction although the healing period is longer. In the presence of a residual gap in the medial surface of the femur in the region of the lesser trochanter, poor results are frequent.