Healing of Atypical Subtrochanteric Femur Fractures after Cephalomedullary Nailing: Which Factors Predict Union?

Jae Woo Cho, Chang Wug Oh, Frankie Leung, Ki Chul Park, Merng Koon Wong, Ernest Kwek, Han Ju Kim, Jong Keon Oh

    Research output: Contribution to journalArticlepeer-review

    38 Citations (Scopus)


    Objectives: The purpose of this study was to determine the healing rate and time to union of atypical subtrochanteric fractures treated with cephalomedullary nailing. Design: Retrospective review, descriptive, and analytic study. Setting: Six level 1 trauma centers. Patients/Participants: The study included 42 patients with 48 displaced, atypical, bisphosphonate-associated subtrochanteric femur fractures who underwent surgical intervention. Intervention: Cephalomedullary femur nailing. Main Outcome Measurement: The main outcome measures were radiologic healing and time to union. Results: The primary healing rate after cephalomedullary nailing of bisphosphonate-associated subtrochanteric femur fractures was 68.7% (33/48 patients). Mean time to union was 10.7 months. Malalignment was determined using the differences in neck-shaft angle (the difference between the normal side and the surgically repaired side) and sagittal angulation. These all proved to be significantly correlated with failure and delayed healing time. The cutoff points for neck-shaft angle, difference in neck-shaft angle, and sagittal angulation were 125.6, 4.4, and 5.5 degrees, respectively (receiver operating characteristic curve analysis). Conclusions: The healing rate of atypical subtrochanteric femur fractures treated with cephalomedullary nailing is lower than that previously reported for atypical femur fractures. The quality of fracture reduction proved to be the most important factor in bony union and time to union.

    Original languageEnglish
    Pages (from-to)138-145
    Number of pages8
    JournalJournal of orthopaedic trauma
    Issue number3
    Publication statusPublished - 2017 Mar 1

    Bibliographical note

    Publisher Copyright:
    Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

    Copyright 2017 Elsevier B.V., All rights reserved.


    • atypical fracture
    • bisphosphonate
    • healing
    • malalignment
    • subtrochanteric femur fracture

    ASJC Scopus subject areas

    • Surgery
    • Orthopedics and Sports Medicine


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