Low-Energy Subtrochanteric Fractures in Elderly Patients

Forty-two patients with subtrochanteric fractures were treated from 1987 through 1990. Of these, 31 patients above 70 years of age (average, 81.9) had nonpathologic low-energy fractures that were internally fixed with a sliding screw-plate device. Subtrochanteric fractures with an associated intertrochanteric component were the most common type. Interfragmentary compression was used in long oblique and spiral fractures and those with large butterfly fragments. Patients were mobilized early and allowed partial weightbearing for 6-8 weeks. There was a 29% mortality rate within 3 months of injury. Of the remaining cases, followed for a minimum of 6 months (average, 11.8 months), 20 (91%) united satisfactorily. There was loss of fixation in one case and one instance of plate fracture. We found, given the special circumstances in elderly patients, that the device was suitable not only for subtrochanteric fractures with an intertrochanteric element but also for four-part fractures and two-part spiral fractures. The sliding screw-plate permitted passage of interfragmentary screws and facilitated medial displacement and collapse, which are valuable in cases with medial comminution in reducing the bending moment on the plate. These factors may help reduce the incidence of plate failure and, coupled with familiarity with its use, make it a reliable implant for such difficult fractures in elderly patients.