Extramedullary vs Intramedullary Fixation for Subtrochanteric Femur Fracture-Outcomes

Dr. Shridhar M D, Dr. Suman N V, Dr. Koti Reddy

Abstract: Aim: The objective of this study to assess the Outcomes of treatment of subtrochanteric femur fracture treated with extramedullary and intramedullary fixation. Introduction: Subtrochanteric femur fractures are difficult to treat due to strong deforming forces at the fracture site, tenuous blood supply and the immense load-bearing forces exerted through the peri-trochanteric region. Adequate reduction and stable fixation are paramount when treating these fractures to optimize patient outcomes. Materials and methods: This study was conducted during November 2022 to may 2024. Total 30 patients with subtrochanteric femur fracture were operated and were followed.21 underwent with Long PFN, 2 patients with DCS, 3 with DHS and 4 gamma nail. All the patients were followed up with serial radiographs post operatively at 1,3,6 ,12 and 24 months. Subjectively functional outcome evaluation done by harris hip score. Results: The data presents a comparison of the mean operating times across different implants used for treating subtrochanteric femur fractures. The Long PFN recorded the shortest average operating time (67.50 minutes), followed closely by the GN (71.19 minutes). The highest mean blood loss was observed with the DCS (145.00 ml), followed by DHS (126.67 ml), indicating more invasive procedures. In contrast, the Long PFN (67.50 ml) and GN (77.14 ml) had notably lower blood loss, suggesting less surgical trauma. The Harris Hip Score at 3 months postoperatively shows Long PFN demonstrated the highest mean score (71.50), followed closely by GN (69.52), indicating slightly better early hip function. DHS and DCS showed slightly lower scores of 68.67 and 67.00 respectively. The assessment of radiological union time among the study participants shows that most fractures united between 16 and 18 weeks. Specifically, 13 patients (43.33%) achieved union at 18 weeks, followed by 10 patients (33.33%) at 16 weeks. A smaller number showed union at 20 weeks (20.00%), and only 1 patient (3.33%) at 17 weeks. Conclusion: Subtrochanteric fractures of the femur remain one of the most challenging injuries in orthopedic trauma, often resulting from high-energy trauma in younger adults or low-energy falls in the elderly. This study comprehensively evaluated the surgical and radiological outcomes of four commonly used implants: Dynamic Condylar Screw, Dynamic Hip Screw, Gamma Nail, and Long Proximal Femoral Nail, In the treatment of 30 patients with subtrochanteric femur fractures. The Long PFN group demonstrated the shortest mean operative time, least intraoperative blood loss, union rate and the highest functional scores across all postoperative intervals. the consistent superiority in clinical parameters suggests that Long PFN is more efficient and less invasive than extramedullary alternatives like DCS and DHS. This study underscores the clinical and surgical efficacy of intramedullary fixation, particularly Long Proximal Femoral Nail, in the management of subtrochanteric femur fractures. The implant demonstrated superior performance across nearly all parameters. Based on the results, Long PFN should be considered the implant of choice in most subtrochanteric fractures, especially those with unstable configurations., the findings support a paradigm shift toward evidence-based implant selection to enhance patient recovery and reduce the burden of complications in orthopedic trauma care.

Keywords: Subtrochanteric fracture, older adults, DHS, DCS, GN, Harris hip score, merle D'aubigne score

How to Cite?: Dr. Shridhar M D, Dr. Suman N V, Dr. Koti Reddy, "Extramedullary vs Intramedullary Fixation for Subtrochanteric Femur Fracture-Outcomes", Volume 14 Issue 8, August 2025, International Journal of Science and Research (IJSR), Pages: 519-525, https://www.ijsr.net/getabstract.php?paperid=SR25809192546, DOI: https://dx.doi.org/10.21275/SR25809192546