subcapital fractures

ORIF displaced in young

Indications

 

< 60 with good bone stock and preserved joint space

 

Reduction

 

Union rates increased with anatomical reduction

 

Options

- closed reduction

- open reduction / if closed reduction fails

 

Accept

- no varus

- < 15o valgus

- < 10o AP plane

 

Background

DefinitionGarden 3 Displaced Subcapital

 

Fracture distal to articular surface & proximal to intertrochanteric region

 

Epidemiology

 

On average 4 years younger than intertrochanteric fracture

 

One year mortality as high as 36%

 

Only 1/3 will return to pre-fracture living environment

Arthroplasty

Indications

 

Patient > 70

 

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

 

Options

 

Hemiarthroplasty

- unipolar monoblock

- unipolar modular