PURPOSE: To review current management options for subtrochanteric fractures of the femur. These fractures behave differently from other proximal femoral fractures and have their own management pitfalls and problems. METHOD: Articles were identified from Medline. Papers on the management of subtrochanteric fractures were assessed, and included if they contained relevant information. The articles were divided into groups depending on the type of management described. Conservative and operative management were considered separately. Operative management was classified according to the type of device used into extramedullary and intramedullary. CONCLUSIONS: Conservative management gives satisfactory results in 56% of patients compared to 70 - 80% for operative methods. The studies on conservative methods are mostly dated, with less stringent outcome measures. Conservative management is safe, and has a low frequency of non-union. It is most applicable in regions where facilities are suboptimal, in patients unfit for surgery, and in children. When considering operative management, intramedullary devices appear to give better results than extramedullary devices, particularly when the medial buttress of the proximal femur is compromised. However, when operative treatment is undertaken, it should be by experienced surgeons using the technique with which they are most familiar.
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