Sanjay Yadav,Shivendra Sinha,Edwin Luther,Naresh Chander Arora,Manish Prasad,Rohit Varma.[J].Chin J Traumatol,2014,17(3):141-145. [doi]
Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center
  
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KeyWord: Subtrochanteric fractures  Intramedullary  Dynamic hip screw
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Author NameAffiliation
Sanjay Yadav Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110010, India 
Shivendra Sinha Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110011, India 
Edwin Luther Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110012, India 
Naresh Chander Arora Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110013, India 
Manish Prasad Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110014, India 
Rohit Varma Department of Orthopedics, Base Hospital and Army College of Medical Sciences, Delhi 110015, India 
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Abstract:
      Objective: The treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. Methods: Thirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. Results: The mean age of patients was 37.53 years. Most were males between 21-40 years old. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100 ml in group A and 200ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. Conclusion: Intramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.
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