Subtrochanteric fractures of the femur treated with the Zickel nail.

In a retrospective study of 41 subtrochanteric fractures treated with Zickel intramedullary nails (with a follow-up period of at least 1 year) there was a union rate of 100 per cent (39/39). Union occurred between 4 and 7 months (average healing time 5.2 months). There were no implant failures. Four patients have had their Zickel nails successfully removed. In 48 per cent of the cases we had some difficulties with the stability of the fracture, and in 14 per cent, all of them long oblique comminuted fractures, skeletal traction was needed for 6 weeks. In nine cases there was a shortening of 1.5-4 cm (average 2 cm). Although our overall experience with the Zickel nail has been favourable in the treatment of non-union of subtrochanteric fractures, and with the elderly patients who had a simple subtrochanteric fracture secondary to minor trauma, we no longer recommend its use in the treatment of subtrochanteric fractures with marked comminution, because it does not give sufficient rotational and axial stability.