Abstract
Subtrochanteric fractures account for 15-20% of all fractures of the proximal femur. They are caused by the high energetic trauma in young people, by the low energy violence in elderly patients with osteoporosis or in patients treated by bisphosphonates appear as an atypical fracture.
Subtrochanteric fractures still pose a challenge to any surgeon. The gold standard of treatment is intramedullary nailing.
Between year 2009 and 2017, we treated 127 patients, 89 men, 38 women, with a subtrochanteric fracture, the mean age was 61 years range 19-91 years. In 64 patients (58%) fractures were healed within 6 months, another 32 patients healed within 9 months.
In 94 patients (86 .5%) fractures were healed within 9 months. Subtrochanteric non-union was developed in 14 patients (13 .5%), that another surgical treatment was addressed.
Treatment of subtrochanterial fractures is fun-damentally surgical at any age. The prerequisite for healing is to reduce the contact and support of the medial cortical bone, restore the axial position and fix the balance of com-pression and tensile load.
Intramedullary nailing has biomechanical advantages that over-weighs the difficult closed reduction, screw cutting and healing disorders. The treatment of subtrochanteric fractures is based on precise reduction, not on the type of implant.
Currently, when minimally invasive methods of treatment are preferred, intramedullary implants are most commonly used. But even a high-quality implant does not compensate reduction errors.
The treatment of non-unions (and mal-unions) is very difficult and the correction of the primary treatment error is always fundamental .