Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction

Purpose: The purpose of the study was to evaluate methods for treatment of femur subtrochanteric fractures using the intramedullary long nail. Materials and Methods: This retrospective study included 44 patients (44 cases) who were available for follow-up for at least one year. The patients had undergone intramedullary fixation specifically with a long nail for traumatic femur subtrochanteric fractures during the period from June 2005 to May 2012 in Chosun University Hospital. The study compares two groups. For group 1, closed reduction was attempted, and group 2 underwent minimal open reduction. Group 1 included 27 cases, and group 2 included 17 cases. Study parameters included injury mechanism, fracture classification according to the Seinsheimer type, nail design, size of skin incision, alignment, bony union time, malunion or nonunion, and complications. Results: Bony union times were 19.4 weeks (group 1) versus 21.4 weeks (group 2), but there were no statistical differences between the two groups with respect to gender, injury mechanism, fracture classification, or nail design. However, there were significant differences between the two groups with respect to skin incision, malalignment, and complications. Gender, injury mechanism, fracture classification, nail design, size of skin incision, minimal open reduction or close reduction, did not show a significant relationship with bony union. However, in cases of malalignment, the possibility of malunion increased 1.5 times per 1° increase in malaligment. Conclusion: In treatment of femur subtrochanteric fracture using intramedullary nail, nonunion rate increases when malalignment occurs. Therefore, anatomical reduction with minimal open reduction is necessary if closed reduction is not satisfactory.