The Clinical Efficacy and Prognostic Impact of Intramedullary Nail Combined With Either Plates or Titanium Cable Internal Fixation in the Treatment of Femoral Subtrochanteric Fractures

AIM: This study aims to compare the clinical efficacy of intramedullary nail combined with plate and intramedullary nail combined with titanium cable approaches in the treatment of femoral subtrochanteric fractures. METHODS: This retrospective analysis included 85 patients who underwent treatment with intramedullary nails combined with plates and titanium cables at Shengzhou People's Hospital between January 2018 and December 2024. Among them, 40 cases received intramedullary nails combined with plates (the plate group) and 45 cases received intramedullary nails combined with titanium cables (the titanium cable group). Clinical data were collected and compared between the two groups of patients, which included surgery duration, length of hospital stay, incision length, blood loss, fluoroscopy time, fracture healing time, follow-up duration, time to first full weight bearing after surgery, quality of fracture reduction, changes in the neck-shaft angle, complications, and Harris Hip Score. RESULTS: In the titanium cable group, both the incision length and intraoperative blood loss were superior to those in the plate group (p < 0.05). Conversely, the fluoroscopy time and fracture-healing time in the plate group were better than those in the titanium cable group (p < 0.05). Furthermore, both surgical time and length of hospital stay were significantly shorter in the titanium cable group than in the plate group; however, this difference did not achieve statistical significance (p > 0.05). Moreover, there were no significant differences in follow-up duration or time to first full weight-bearing between the two groups (p > 0.05). In the plate group, 2 cases were presented with postoperative complications (5.00%), including 1 case of cerebral infarction and 1 case of deep vein thrombosis. In the titanium cable group, 6 cases had postoperative complications (13.33%), which included 3 cases of delayed varus, 1 case of delayed healing, 1 case of acute coronary syndrome (ACS) combined with delayed varus, and 1 case of nonunion. However, the difference in the overall incidence of postoperative complications between the two groups was not statistically significant (χ2 = 0.886, p = 0.347). Additionally, no statistically significant differences were observed in the quality of fracture reduction and changes in the neck-shaft angle between the two groups (p > 0.05). Similarly, the Harris Hip Score at the last follow-up between the two groups did not differ significantly (χ2 = 2.011, p = 0.156). CONCLUSIONS: Internal fixation with intramedullary nails combined with titanium cables for unstable femoral subtrochanteric fractures offers advantages of a smaller incision length and less intraoperative blood loss. In contrast, internal fixation with intramedullary nails combined with locking plates requires less fluoroscopy time, faster fracture healing, and fewer complications. Both approaches have specific strengths and limitations, providing promising guidance for surgical decision-making and achieving favorable outcomes.