Results of different types of internal fixation in subtrochanteric fractures

Forty six patients, 32 males and 14 females with closed subtrochanteric fractures of the femur were treated surgically in Khoula Hospital Muscat, Sultanate of Oman in the period 1990 -1993. Their age was 17 - 58 years, mean 36. The cause of injury was road traffic accident 33, industrial accident 6, sports trauma 2, fall from height 5. According to Waddell's classification the fracture was Type I in 8 cases, Type II in 4 cases and Type III in 34 cases. They were treated, initially with skin traction. Surgery was done when the general condition and other injuries allowed. The delay before surgery ranged between one and 11 days, average 5. The method of fixation used was dynamic hip screw in 27, dynamic condylar screw in 5, condylar blade-plate in 3 and interlocking intramedullary nail in 11 cases. Post-operative ambulation depended on the presence or absence of other injuries. Full weight bearing was allowed after fracture union. Type I and Type II fractures healed well with no complications. Type III fractures were associated with valgus reduction in 16.7% of the cases treated with DHS, varus reduction in 40% of cases treated with DCS and flexion-abduction position of the main proximal fragment in 57.1% of cases of closed intramedullary nailing. Deep infection occurred in one case. Loosening of the hip screw occurred in 2 cases treated with DCS. No cases of delayed or non-union were encountered. The results in general were satisfactory and comparable with those reported in the literature during the last 2 decades