Outcomes of Subtrochanteric Fractures; A Prospective Study Focusing on the Comparison of Open and Closed Surgical Technique

Abstract

Objective: To review the outcome of surgery by looking at function, deformity and pain according to Harris Hip Score comparing two surgical procedures i.e. open technique and closed technique using relatively recently developed implants.
Methodology: This comparative prospective study was conducted in the department of orthopaedic surgery PIMS Islamabad, from June 2013 to May 2015. By using purposive sampling patients aged 20-50 years with closed subtrochanteric fractures of less than 2 weeks duration were included in the study. The patients with open fractures, pathological fractures, multiple fractures/ poly trauma, and old and neglected fractures of more than 2 weeks were excluded. All included cases of subtrochanteric fractures were managed by either closed technique, using Proximal Femur nail (PFN) or open technique using a Proximal Femur anatomical locking plate (PFP). This comparative study was planned to determine union rates, complications & functional outcome of fixation of subtrochanteric fractures.  Descriptive analysis was done using SPSS version 20. Chi-square test was applied for comparing qualitative variables.
Results: A total of 100 cases were included in the study with the mean age was 38.5 ± 8.6 years in the open technique group () while 34.6 ± 1.2 years in closed technique (). There are 72 males and 28 females.  Union occurred 84% in open technique and 96% in closed technique.  In open technique group mean Harris hip score was 68.9 ±5.4 compared to 72.4 ± 6.2 in the closed technique group (p-value <0.001). In open technique group 6 (12.0%) cases had delayed union and 2 (4.0%) had non-union compared to 3 (6.0%) cases and 1 (2.0%) cases in closed technique group respectively.
Conclusion: Outcome favours closed technique compared to open technique for subtrochanteric fractures fixation, when assessed on Harris hip Score. There was no statistically significant difference in the fracture union and frequency of complications between the two groups.