Intramedullary nailing of subtrochanteric femur fractures caused by low velocity gunshots

Background: Subtrochanteric femur fractures remain challenging injuries to treat. There is paucity of literature evaluating their outcomes and complications following low-velocity civilian gunshots. The purpose of this study is to evaluate the results of intramedullary nailing of subtrochanteric femur fractures secondary to low-velocity gunshots. Methods: A retrospective review of clinical and radiological data was performed on all patients who sustained subtrochanteric femur fractures (AO type 32C3) caused by low-velocity civilian gunshots treated at a single institution between March 2008 and December 2014. Data was analysed to determine the time to union, post-operative complication rates and patient outcomes. Radiographic evidence of healing was defined as bridging callus on three of four cortices on two orthogonal views. Results: Fifty-one patients (48 men and two women) were identified. Mean age was 28 years (range 16–50 years). The predominant method of fixation was a cephalomedullary nail in 43 patients (84%), and eight patients had locking into the lesser trochanter. Thirty patients with a mean follow-up period of 3.3 weeks (0–6 weeks) were lost to follow-up. Twenty-one patients had adequate radiographic and clinical follow-up data suitable for analysis. The mean follow-up period was 24.8 weeks (range 2–40 weeks) for this group. The average time to union was 17.2 weeks (7–40 weeks). Seven fractures (37%) had delayed union. None of the patients required additional surgery. Union was achieved in all cases and no implant failure occurred. Conclusion: This study demonstrates that intramedullary nail fixation of subtrochanteric femur fractures caused by low-velocity civilian gunshots is an acceptable option for the treatment of these injuries with good union rates and low complication rates.