Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction.

INTRODUCTION: Subtrochanteric fractures are more difficult to treat than other proximal femoral fractures. The aim of this study was to report the outcomes for patients with subtrochanteric fractures treated using a cephalomedullary nail following open reduction and cerclage wiring versus closed reduction alone, regarding health-related quality of life (HRQoL) and social function. MATERIALS AND METHODS: We performed a prospective cohort study including patients aged 60 years or older suffering fragility subtrochanteric fractures of the femur treated with cephalomedullary nails, with a minimum 2-year follow-up. We defined two treatment groups: one treated with closed reduction manoeuvres (60 patients), and another treated with open reduction and cerclage wiring (30 patients). The outcomes were mortality, orthopaedic complications (reoperation and no-union), social function (Jensen Index), and HRQoL (EQ-5D index score). RESULTS: There were no differences regarding sex, age, side affected, type of implant, anaesthetic risk, 1-year mortality, and orthopaedic complications. Surgical time was longer in the cerclage wire group, but length of stay was 2 days shorter for the cerclage group and reduction was better. Patients treated with cerclage wiring had significantly better EQ-ED at 12 months (0.66 ± 0.22 points vs. 0.78 ± 0.15 points); and social status at 12 and 18 months (2.77 ± 1.00 points vs. 2.10 ± 1.22 points). CONCLUSIONS: Better reduction is achieved when using cerclage wires for fragility subtrochanteric fractures. These fractures had a negative effect on quality of life and social function, but better outcomes were observed in the cerclage group.

Cerclage Wiring Through a Mini-Open Approach to Assist Reduction of Subtrochanteric Fractures Treated With Cephalomedullary Fixation: Surgical Technique.

Despite advances in the management of subtrochanteric fractures, in particular with the use of cephalomedullary nails, outcomes remain worse than other fractures of the proximal femur. Because an anatomic reduction is needed to offer the best results, several methods of reduction, using clamps and wires have been described. Reduction of fractures in elderly patients is especially complicated because of poor bone quality, comorbidities, and unfavorable fracture patterns. We describe a new technique of reduction and cerclage wiring through a mini-open approach for isolated subtrochanteric, as well as intertrochanteric fractures with extension into the subtrochanteric area, and report our results in a series of patients.