Overview
The subtrochanteric region is the upper shaft of the femur just below the lesser trochanter. This area carries enormous bending and torsional loads with walking, which makes it one of the highest-stress sites in the skeleton. Fractures here are notorious for delayed union and implant failure if fixation is suboptimal.
These fractures also have a well-known association with long-term bisphosphonate use — so-called atypical femoral fractures — which present with a specific radiographic pattern and often require bilateral evaluation.
Why it's done
Subtrochanteric fracture fixation is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Virtually all displaced subtrochanteric fractures
Non-operative treatment cannot hold alignment.
Atypical femoral fracture
Prophylactic or therapeutic nailing is standard.
Pathologic fracture
Nailing provides pain control and stabilization.
Reverse-oblique pattern extending from above
Cephalomedullary nailing is strongly preferred.
Significant shortening or angulation
Restoration of length and alignment is essential.
How it works
A long cephalomedullary nail is passed down the femur through a small incision at the top of the hip. A large lag screw or helical blade is driven up into the femoral head, and distal locking screws capture the shaft.
Reduction is critical in this region — particularly restoration of the medial cortical buttress, valgus alignment, and rotation — to minimize implant stress. Cerclage cables or wires are sometimes added for comminuted or oblique patterns.
Recovery
Protected weight-bearing is common during early recovery, especially in atypical femoral fractures, which are prone to delayed union. Hip and knee range-of-motion exercises begin early. Union takes time on average, sometimes longer. Implant failure and nonunion remain risks if reduction is inadequate. Hardware removal is uncommon unless a specific problem develops.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a high-energy fracture below the lesser trochanter that is mechanically unstable and will not unite without fixation. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before subtrochanteric fracture fixation include:
- bleeding and infection
- anesthesia risk
- blood clot (DVT/PE)
- non-union or delayed union (more common here than in other hip fractures)
- mal-union with varus or rotational deformity
- hardware failure
- leg-length discrepancy
The indication to proceed is a subtrochanteric femur fracture requiring cephalomedullary nail stabilization. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: