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J Am Acad Orthop Surg, Vol 15, No 11, November 2007, 663-671.
© 2007 the American Academy of Orthopaedic Surgeons
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Subtrochanteric Femoral Fractures

Douglas W. Lundy, MD, FACS

Dr. Lundy is Orthopaedic Trauma Surgeon, Resurgens Orthopaedics, Marietta, GA.

Neither Dr. Lundy nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Lundy, Resurgens Orthopaedics, Suite 1100, 61 Witcher, Marietta, GA 30060.

Subtrochanteric femoral fractures are complicated injuries that may be associated with other life-threatening conditions. Patients should be carefully evaluated and appropriately treated for hypovolemic shock. These fractures can be effectively stabilized with 95° plates, femoral reconstruction nails, or trochanteric femoral nails with interlocking options. Nails produce very stable constructs and consistently can be placed with the patient in the lateral position on the radiolucent table or in the supine position on the fracture table. Standard antegrade femoral nails may be indicated in certain fracture patterns. The 135° hip screw-plate is not suitable in the treatment of subtrochanteric femoral fractures; use of these implants may result in loss of fixation and fracture displacement. Chemical and mechanical prophylaxis for deep vein thrombosis should be initiated unless contraindicated by other medical comorbidities. An accurate reduction and excellent surgical technique with minimal soft-tissue dissection can routinely produce good results without the need for secondary procedures.






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Copyright © 2007 by the American Academy of Orthopaedic Surgeons.