Citation Information :
Mehta NJ, Goldsmith T, Lacey A, Reddy G, Selvaratnam V, Ramakrishnan M. Outcomes of Intramedullary Nailing with Cerclage Wiring in Subtrochanteric Femoral Fractures. 2019; 14 (1):29-33.
Aims: The aim of this study was to compare the outcomes of closed reduction against open reduction with cerclage wires in patients with subtrochanteric fractures treated with intramedullary nailing (IMN).
Materials and methods: We identified 141 patients who had an IMN over a 4-year period. They were classified into three groups based on fracture pattern and whether open or closed reduction was performed. Type I was a transverse fracture, type II, a spiral fracture with an intact posterior and medial wall in the proximal fragment, and a type III fracture without intact posterior or medial walls. The primary outcome measure was a revision surgery for implant failure. Secondary outcome measures were related to fracture reduction and radiological union scores of the hip (RUSH).
Results: There were 35 patients who had a type I fracture, 26 patients with a type II fracture, and 80 patients with a type III fracture. The mean follow-up was 7 months. Closed reduction in type III fractures was associated with a significantly increased risk of mechanical complications (p = 0.005) and unplanned returns to theatre for implant failure (p = 0.04) as compared to open reduction. Open reduction in type III fractures was associated with a significantly higher mean RUSH scores (p = 0.0006). There was no significant difference in mean operative time between open and closed reduction in type III fractures (p = 0.12).
Conclusion: We recommend open reduction with cerclage wiring in type III subtrochanteric fractures in order to reduce the risk of implant failure, nonunion, and need for further surgery.
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