PFNA with reduction assisted with pointed clamp and cable cerclagefor select subtrochanteric fractures of the femur

Purpose: The purpose of this study was to evaluate a series of select subtrochanteric fractures who were treated with PFNA with reduction assisted with pointed clamp and cable cerclage and to determine the effect of this technique on reduction quality, and to provide our recommendations. Methods: Between August 2011 and February 2013, 13 patients with a subtrochanteric femoral fracture (six oblique fractures and seven spiral fractures) were treated with PFNA with reduction assisted with pointed clamp. If loss of reduction occurred after release the forceps, a supplementary cable cerclage was used to restore displacement. Radiographs were evaluated for the quality of the reduction and fracture union progress. The functional outcome was assessed by Harris hip score. All patients were followed up for at least 12 months. Results: All 13 fractures were healed at an average of 20 weeks (range 16-24 weeks). Five fractures occurred loss of reduction after release the forceps, and a single cable was used for each of those patients. The mean neck-shaft angle was restored to within 5°, and the average translation decreased from 2.05 cm preoperatively to 0.15 cm postoperatively. All patients achieved a good or excellent functional result with a mean Harris hip score of 90.7 (range 83-95). After follow-up of at least 12 months, no patient had a symptomatic leg length discrepancy or rotational malunion. Conclusion: Treatment of subtrochanteric fractures with reduction assisted with pointed clamp and cable cerclage and PFNA fixation techniques can result in preferable reductions and a high union rate.