Cerclage Cable and Long Proximal Femoral Nail Antirotation Fixation in Treatment of Subtrochanteric Fractures: Functional and Radiological Outcomes and Complications

Abstract

Objective: We aimed to present the radiological and functional outcomes and complications of intramedullary nailing with long proximal femoral nail antirotation (PFNA) and cerclage cable for spiral and oblique subtrochanteric femoral fractures. Methods: The study included patients who underwent intramedullary nailing with long PFNA and cerclage cable due to closed, isolated, and spiral/oblique subtrochanteric femoral fractures and were followed up for at least one year. Fracture union was evaluated with anteroposterior and oblique radiographs of patients obtained at 2, 4, 6, and 12 months, postoperatively. Functional evaluation was done using lower extremity functional scale (LEFS) and visual analog scale (VAS). Results: The mean time to union was 20.16±2.8 (range: 16-28) weeks, mean LEFS score of the patients was 74.08±2.3 (range: 70-80), and LEFS percentage was calculated as 92.75±16.20 (range: 88-100). Radiological evaluation of the reduction quality revealed that good results were acquired in 28 (84.8%) patients, whereas acceptable results were acquired in five (15.2%). The mean VAS score was 0.84±1.17 (range: 0-4). Radiological and clinical union was achieved in 32 (97%) patients within 6 months and union was achieved with some delay in one patient (3%) within 7 months Conclusion: Subtrochanteric femur region is an area that is subject to complications due to its anatomic position and functional characteristics. The treatment for spiral/oblique subtrochanteric femur fractures with PFNA and cerclage cable is a reliable method that increases the stability of the fixation, allows early mobilization and weight bearing, and helps in the acquisition of satisfactory radiological and functional results.