Operative stabilization of subtrochanteric fractures of the femur.

The records and radiographs of 35 patients with 36 fractures of the subtrochanteric area of the femur stabilized by either angle blade plate (ABP) or dynamic hip screw (DHS) fixation were retrospectively reviewed to evaluate and compare the efficacy of these two implants in the management of these injuries. Twenty of the 36 fractures were managed by ABP stabilization and 16 fractures by DHS stabilization. In each case, a priority was placed on reconstitution of the medial cortex, either by anatomic reduction and stabilization or by the liberal use of cancellous bone grafting. The patients were evaluated for fracture pattern, integrity of the reconstructed medial cortex, time to union, and complications related to implant use. The two fracture classification systems used in this report (Waddell or Sensheimer), although helpful in preoperative planning, did not provide prognostic insight into fracture healing. All 31 fractures with an acceptable reconstitution of the medial cortex united primarily. Three of the five fractures without an acceptable medial buttress united primarily, one required reoperation for a delayed union with implant failure, and one patient had a fatal pulmonary embolism. This study demonstrates the acceptability of either implant in the management of subtrochanteric fractures provided strict adherence to reconstruction of the medial cortex is accomplished.