Comparative Study of Proximal Femoral Nailing in Trochanteric and Subtrochanteric Fractures with or Without Cerclage Cable Augmentation

Objective: This study aimed to examine the effect of the use of proximal femoral nail (PFN) and cable cerclage on the radiological and functional results and correlation with complications such as non-union and malunion, in cases of trochanteric and subtrochanteric femur fractures. Material and Method: The study included patients treated with PFN and/or cable cerclage because of closed, isolated spiral/oblique subtrochanteric and trochanteric fractures with a minimum follow-up period of 1 year. Patients were excluded if they had a pathological fracture, open fracture, any additional fracture, or if the epiphyseal line was open. The fractures were classified according to the AO/OTA classification. Bone union was evaluated on anteroposterior and lateral/oblique radiographs taken at postoperative 2, 4, 6, and 12 months. Functional evaluation was made according to the lower extremity functional scale and visual analog scale. Results: The time to union was a mean of 20 weeks (range, 16-28 weeks) for patients treated with PFN + cable and a mean of 17 weeks (range, 17-32 weeks) for the group treated with PFN alone. In the lower extremity functional evaluation scale, the mean score was 74 (range, 74-80) and the percentage was calculated as 93% (88-100%) in the study group, and the mean score was 55 (range, 20-74) and 56% (35-93%) in the control group. According to the Baumgartner et al criteria for radiological reduction quality evaluation, 33 patients were reported as good, 17 patients as acceptable, and 8 patients as poor. Radiological and clinical union was obtained within 6 months in 45 patients. Delayed union was determined in 1 patient in the study group and in 3 patients in the control group. Although the PFN-only group showed slightly faster union, this may reflect differences in age distribution or fracture complexity rather than treatment superiority. (Figure 1 shows a representative postoperative X-ray of a PFN with cerclage). Conclusion: The results of this study demonstrated that the use of PFN and cable cerclage is a reliable method in the treatment of trochanteric and subtrochanteric fractures, which increases fixation stability, allows early mobilisation and weight-bearing, and may provide improved functional outcomes. Surgical success and patient functionality will be increased with the additional use of cable cerclage in patients with a free unstable fracture where an acceptable closed reduction cannot be made.