Skip to main content

Subtrochanteric Fractures

  • Chapter
Hip Fractures

Abstract

Subtrochanteric fractures those between the lesser trochanter and the isthmus (narrowest portion) of the femoral shaft (Figure 7.1) —account for approximately 5% to 34% of all hip fractures.1 Boyd and Griffin, in a review of 300 hip fractures, classified 26.7% as subtrochanteric.2 Michelson et al. reported that 14% of hip fractures in patients over age 50 years were located in the subtrochanteric region.3 At the Hospital for Joint Diseases, subtrochanteric fractures account for approximately 5% of hip fractures in patients over 65 years of age. A review of retrospective studies reveals that the incidence of these fractures exhibits a bimodal age distribution, with high-energy injuries occurring more frequently in younger individuals and low-energy injures occurring more frequently in the elderly.4–7

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Russell TA, Taylor JC. Subtrochanteric fractures of the femur. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia: WB Saunders, 1992:1485–1524.

    Google Scholar 

  2. Boyd HB, Griffin LL. Classifications and treatment of trochanteric fractures. Arch Surg 1949; 58:853–866.

    Article  PubMed  CAS  Google Scholar 

  3. Michelson JD, Myers A, Jinnah R, et al. Epidemiology of hip fractures among the elderly: risk factors for fracture type. Clin Orthop 1995; 311:129–135.

    PubMed  Google Scholar 

  4. Berman AT, Metzger PC, Bosacco SJ, et al. Treatment of the subtrochanteric fracture with the compression hip nail-a review of thirty-eight consecutive cases. Orthop Trans 1979; 3:225–256.

    Google Scholar 

  5. Robey LR. Intertrochanteric and subtrochanteric fractures of the femur in the Negro. J Bone Joint Surg Am 1956; 38:1301–1312.

    PubMed  Google Scholar 

  6. Velasco RU, Comfort T. Analysis of treatment problems in subtrochanteric fractures of the femur. J Trauma 1978; 18:513–522.

    Article  PubMed  CAS  Google Scholar 

  7. Waddell JP. Subtrochanteric fractures of the femur: a review of 130 patients. J Trauma 1979; 19:585–592.

    Article  Google Scholar 

  8. Koch JC. The laws of bone architecture. Am J Anat 1917; 21:177–298.

    Article  Google Scholar 

  9. Frankel VH, Burstein AH. Orthopaedic Biomechanics. The Application of Engineering to the Musculoskeletal System. Philadelphia: Lea & Febiger, 1970.

    Google Scholar 

  10. Russell TA, Taylor JC. Subtrochanteric fractures of the femur. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, eds. Skeletal Trauma. Philadelphia: WB Saunders, 1992:1883–1925.

    Google Scholar 

  11. Bergman GD, Winquist RA, Mayo KA, Hansen STJ. Subtrochanteric fracture of the femur: fixation using the Zickel nail. J Bone Joint Surg Am 1987; 69:1032–1040.

    PubMed  CAS  Google Scholar 

  12. Sangeorzan BJ, Ryan JR, Salciccroli GG. Prophylactic femoral stabilization with the Zickel nail by closed technique. J Bone Joint Surg Am 1986; 68:991–999.

    PubMed  CAS  Google Scholar 

  13. Jekic M, Jekic I. Primary management and problems with osteosynthesis of subtrochanteric fractures of the femur. Helv Chir Acta 1993; 59:553–555.

    PubMed  CAS  Google Scholar 

  14. Bone L, Bucholz R. The management of fractures in the patient with multiple trauma. J Bone Joint Surg Am 1986; 68:945–949.

    PubMed  CAS  Google Scholar 

  15. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 1985; 25:375–384.

    Article  PubMed  CAS  Google Scholar 

  16. Fielding JW, Magliato HJ. Subtrochanteric fractures. Surg Gynecol Obstet 1966; 122:555–560.

    PubMed  CAS  Google Scholar 

  17. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978; 60:300–306.

    PubMed  CAS  Google Scholar 

  18. Muller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classifications of Fractures of Long Bones. Berlin: Springer-Verlag, 1990.

    Book  Google Scholar 

  19. Hanson GW, Tullos HS. Subtrochanteric fractures of the femur treated with nail plate devices: a retrospective study. Clin Orthop 1978; 131:191–194.

    PubMed  Google Scholar 

  20. Teitge RA. Subtrochanteric fracture of the femur. J Bone Joint Surg Am 1976; 58:282.

    Google Scholar 

  21. Whatley JR, Garland DE, Whitecloud T, Wickstrom J. Subtrochanteric fractures of the femur: treatment with ASIF blade plate fixation. South Med J 1978; 17:1372–1375.

    Article  Google Scholar 

  22. Asher MA, Tipper JW, Rockwood CA, Zilber S. Compression fixation of subtrochanteric fractures. Clin Orthop 1976; 117:202–208.

    PubMed  Google Scholar 

  23. Van Meeteren M, Van Rief Y, Roukema J, Van der Werken C. Condylar plate fixation of subtrochanteric femoral fractures. Injury 1996; 27:715–717.

    Article  PubMed  Google Scholar 

  24. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur: results of treatment with the 95-degree condylar blade plate. Clin Orthop 1989; 238:122–130.

    PubMed  Google Scholar 

  25. Sanders R, Regazzoni P, Routt M. The treatment of subtrochanteric fractures of the femur using the dynamic condylar screw. Paper presented at the annual meeting of the American Academy of Orthopaedic Surgeons, Atlanta, GA, February 1988.

    Google Scholar 

  26. Pai C. Dynamic condylar screw for subtrochanteric femur fractures with greater trochanteric extension. J Orthop Trauma 1996; 10:317–322.

    Article  PubMed  CAS  Google Scholar 

  27. Nungu K, Olerud C, Rehnberg L. Treatment of subtrochanteric fractures with the AO dynamic condylar screw. Injury 1993; 24:90–92.

    Article  PubMed  CAS  Google Scholar 

  28. Wile PB, Panjabi MM, Southwick WO. Treatment of subtrochanteric fractures with a high-angle compression hip screw. Clin Orthop 1983; 175:72–78.

    PubMed  Google Scholar 

  29. Ruff ME, Lubbers LM. Treatment of subtrochanteric fractures with a sliding screwplate device. J Trauma 1986; 26:75–80.

    Article  PubMed  CAS  Google Scholar 

  30. Mullaji AB, Thomas TL. Low-energy subtrochanteric fractures in elderly patients: results of fixation with the sliding screw plate. J Trauma 1993; 34:56–61.

    Article  PubMed  CAS  Google Scholar 

  31. Ceder L, Lunsjo L, Olson O, et al. Different ways to treat subtrochanteric fractures with the Medoff sliding plate. Clin Orthop 1998; 348:101–106.

    PubMed  Google Scholar 

  32. Chapman MW. The role of intramedullary nailing in fracture management. In: Browner BD, Edwards CD, eds. The Science and Practice of Intramedullary Nailing. Philadelphia: Lea & Febiger, 1987:17–23.

    Google Scholar 

  33. Ovadia DN, Chess DN. Intraoperative and postoperative subtrochanteric fracture of the femur associated with removal of the Zickel nail. J Bone Joint Surg Am 1988; 70:239–243.

    PubMed  CAS  Google Scholar 

  34. Chapman MW, Bowman WE, Csongradi JJ, et al. The use of Enders pins in extracapsular fractures of the hip. J Bone Joint Surg Am 1981; 63:14–28.

    PubMed  CAS  Google Scholar 

  35. Jensen JS, Sonne-Holm S, Tondevold E. Critical analysis of Ender nailing in the treatment of trochanteric fractures. Acta Orthop Scand 1980; 51:817–825.

    Article  PubMed  CAS  Google Scholar 

  36. Kuderna H, Bohler N, Collon DJ. Treatment of intertrochanteric and subtrochanteric fractures of the hip by the Ender method. J Bone Joint Surg Am 1976; 58:604–611.

    PubMed  CAS  Google Scholar 

  37. Lund B, Hogh J, Lucht U. Trochanteric and subtrochanteric fractures. One year follow-up of a prospective study of Ender and McLaughlin osteosynthesis. Acta Orthop Scand 1981; 52:645–648.

    Article  PubMed  CAS  Google Scholar 

  38. Raugstad TS, Molster A, Haukeland W, et al. Treatment of pertrochanteric and subtrochanteric fractures of the femur by the Ender method. Clin Orthop 1979; 138:231–237.

    PubMed  Google Scholar 

  39. Alho A, Ekeland A, Stromsoe KN. Subtrochanteric femoral fractures treated with locked intramedullary nails: experience from 31 cases. Acta Orthop Scand 1992; 62:573–576.

    Google Scholar 

  40. Wu CC, Shih CH, Lee ZL. Subtrochanteric fractures treated with interlocking nailing. J Trauma 1991; 31:326–333.

    Article  PubMed  CAS  Google Scholar 

  41. Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop 1992; 283:231–236.

    PubMed  Google Scholar 

  42. Slater J, Taylor J, Russell T, Walker B. Intramedullary nailing of complex subtrochanteric fractures of the femur. Orthop Trans 1991; 15:774.

    Google Scholar 

  43. Taylor D, Erpelding J. Treatment of comminuted subtrochanteric femoral fractures in a young population with a reconstruction nail. Mil Med 1996; 161:735–738.

    PubMed  CAS  Google Scholar 

  44. French B, Tornetta P. Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop 1998; 348:95–100.

    PubMed  Google Scholar 

  45. Wiss DA, Matta JM, Sima W, Reber L. Subtrochanteric fractures of the femur. Orthopaedics 1985; 8:793–800.

    CAS  Google Scholar 

  46. Wiss DA, Fleming CH, Matta J, Clark D. Commuted and rotationally unstable fractures treated with an interlocking nail. Clin Orthop 1986; 212:35–37.

    PubMed  Google Scholar 

  47. Wiss DA, Brien WW, Stetson WB. Interlocked nailing for treatment of segmental fractures of the femur. J Bone Joint Surg Am 1990; 72:724–728.

    PubMed  CAS  Google Scholar 

  48. Wiss DA, Brien WW, Becker V Jr. Interlocking nailing for the treatment of femoral fractures due to gunshot wounds. J Bone Joint Surg Am 1991; 73:598–606.

    PubMed  CAS  Google Scholar 

  49. Brumback R, Ellison T, Molligan H, et al. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 1992; 74:1450–1455.

    PubMed  CAS  Google Scholar 

  50. Brumback RJ, Reilly JP, Poka A, et al. Intramedullary nailing of femoral shaft fractures: part I. Decision making errors with interlocking fixation. J Bone Joint Surg Am 1988; 70:1441–1452.

    PubMed  CAS  Google Scholar 

  51. Ebraheim N, Mekhail A, Checroun A. Entry point of reconstruction nail. Am J Orthop 1998; 27:474–476.

    PubMed  CAS  Google Scholar 

  52. Stewart MJ. Discussion of paper. Classification, treatment and complications of the adult subtrochanteric fracture. J Trauma 1964:481.

    Google Scholar 

  53. DeLee JC, Clanton TO, Rockwood CAJ. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am 1982; 63:773–779.

    Google Scholar 

  54. Johnson KD. Current techniques in the treatment of subtrochanteric fractures. Techniques in Orthopaedics 1988; 3:14–24.

    Article  Google Scholar 

  55. Walling A, Bahner R. Pathological fractures. In: Koval K, Zuckerman J, eds. Fractures in the Elderly. Philadelphia: Lippincott-Raven, 1998:247–259.

    Google Scholar 

  56. Present D, Shaffer B. Evaluation and management of pathologic fractures. In: Zuckerman J, ed. Comprehensive Care of Orthopaedic Injuries in the Elderly. Baltimore: Urban & Schwarzenberg, 1990:513–532.

    Google Scholar 

  57. Harrington K. Orthopaedic Management of Metastatic Bone Disease. St. Louis: CV Mosby, 1988.

    Google Scholar 

  58. Barlow I, Thomas N. Reconstruction nailing for subtrochanteric fractures in the Pagetic femur. Injury 1994; 25:426–428.

    Article  PubMed  CAS  Google Scholar 

  59. Karachalios T, Atkins R, Sarangi P, et al. Reconstruction nailing for pathological subtrochanteric fractures with coexisting femoral shaft metastases. J Bone Joint Surg Br 1993; 75:119–122.

    PubMed  CAS  Google Scholar 

  60. Broos P, Reynders P, Van Den Bogert W, Vanderschot P. Surgical treatment of metastatic fracture of the femur: Improvement of quality of life. Acta Orthop Belg 1993; 59:52–56.

    PubMed  Google Scholar 

  61. Haentjens P, De Neve W, Casteleyn P, Opdecam P. Massive resection and prosthetic replacement for the treatment of metastases of the trochanteric and subtrochanteric femoral region: bipolar arthroplasty versus total hip arthroplasty. Acta Orthop Belg 1993; 59:367–371.

    Google Scholar 

  62. Zuckerman JD. Comprehensive Care of Orthopaedic Injuries in the Elderly. Baltimore: Urban & Schwarzenberg, 1990.

    Google Scholar 

  63. Aronoff PM, Davis PMJ, Wickstrom JK. Intramedullary nail fixation as treatment of subtrochanteric fractures of the femur. J Trauma 1971; 11:637–650.

    Article  PubMed  CAS  Google Scholar 

  64. Stoffelen D, Haentjens P, Reynders P, et al. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Acta Orthop Belg 1994; 60:135–139.

    PubMed  Google Scholar 

  65. Merle d’Aubigne R. Cotation chiffree de la fonction de la hanche. Rev Chir Orthop Reparatrice Appar Mot 1970; 56:481–486.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media New York

About this chapter

Cite this chapter

Koval, K.J., Zuckerman, J.D. (2000). Subtrochanteric Fractures. In: Hip Fractures. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4052-3_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-4052-3_7

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-4054-7

  • Online ISBN: 978-1-4757-4052-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics