Volume 8, Issue 1 (6-2026)
Tabari Biomed Stu Res J 2026, 8(1): 33-39 |
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Closed Versus Limited Open Reduction in the Treatment of Subtrochanteric Femoral Fractures: A Narrative Review. Tabari Biomed Stu Res J 2026; 8 (1) :33-39
URL: http://tbsrj.mazums.ac.ir/article-1-3912-en.html
URL: http://tbsrj.mazums.ac.ir/article-1-3912-en.html
Abstract:
Subtrochanteric femoral fractures are difficult to reduce because powerful muscular forces displace the short proximal fragment into flexion, abduction, and external rotation, while the predominantly cortical fracture zone is exposed to high bending stresses. Cephalomedullary nailing is the preferred fixation strategy, but the optimal method of obtaining reduction remains debated. This narrative review compares closed reduction with limited open reduction in adults undergoing intramedullary fixation. Closed reduction preserves the fracture hematoma and periosteal envelope and is generally associated with shorter operations and less blood loss. Nevertheless, repeated manipulations, prolonged fluoroscopy, or acceptance of varus alignment and a residual medial gap may negate these advantages. Limited open reduction permits direct or clamp-assisted restoration of length, rotation, and medial cortical continuity; selected simple or long-oblique patterns may also benefit from percutaneous cerclage. Contemporary observational evidence does not show a consistent increase in deep infection or non:union: after a carefully performed limited exposure, although superficial infection, transfusion, and operative time may increase. Across studies, the quality of reduction appears more important than the label of the reduction technique. A pragmatic closed-first strategy is therefore appropriate, with timely conversion to limited open reduction when acceptable alignment cannot be obtained efficiently. The decision should be individualized according to fracture morphology, soft-tissue condition, surgeon experience, and the ability to restore the medial buttress without extensive periosteal stripping. High-quality prospective comparative studies using standardized reduction criteria and patient-reported outcomes are still required.
Keywords: Femoral Fractures, Fracture Fixation, Intramedullary, Fracture Reduction, Closed, Open Fracture Reduction, Bone Malalignment
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