• J Orthop Trauma · Mar 2017

    Multicenter Study

    Healing of Atypical Subtrochanteric Femur Fractures After Cephalomedullary Nailing: Which Factors Predict Union?

    • Jae-Woo Cho, Chang-Wug Oh, Frankie Leung, Ki-Chul Park, Merng Koon Wong, Ernest Kwek, Han-Ju Kim, and Jong-Keon Oh.
    • *Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea; †Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea; ‡Department of Orthopaedic Surgery, Queen Mary Hospital, Hong Kong, China; §Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri-si, Korea; ‖Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; and ¶Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
    • J Orthop Trauma. 2017 Mar 1; 31 (3): 138-145.

    ObjectivesThe purpose of this study was to determine the healing rate and time to union of atypical subtrochanteric fractures treated with cephalomedullary nailing.DesignRetrospective review, descriptive, and analytic study.SettingSix level 1 trauma centers.Patients/ParticipantsThe study included 42 patients with 48 displaced, atypical, bisphosphonate-associated subtrochanteric femur fractures who underwent surgical intervention.InterventionCephalomedullary femur nailing.Main Outcome MeasurementThe main outcome measures were radiologic healing and time to union.ResultsThe primary healing rate after cephalomedullary nailing of bisphosphonate-associated subtrochanteric femur fractures was 68.7% (33/48 patients). Mean time to union was 10.7 months. Malalignment was determined using the differences in neck-shaft angle (the difference between the normal side and the surgically repaired side) and sagittal angulation. These all proved to be significantly correlated with failure and delayed healing time. The cutoff points for neck-shaft angle, difference in neck-shaft angle, and sagittal angulation were 125.6, 4.4, and 5.5 degrees, respectively (receiver operating characteristic curve analysis).ConclusionsThe healing rate of atypical subtrochanteric femur fractures treated with cephalomedullary nailing is lower than that previously reported for atypical femur fractures. The quality of fracture reduction proved to be the most important factor in bony union and time to union.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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