[13,5,9] A laboratory study (Mahomed et al, 1994) comparing a locked Gamma nail to a standard sliding hip screw for the fixation of stable and unstable subtrochanteric
fractures showed that the intramedullary nail was more rigid and permitted less fracture displacement and concluded that intramedullary fixation was superior to extramedullary fixation.
Sheeraz et al., "Treatment of Crowe IV high hip dysplasia with total hip replacement using the Exeter stem and shortening derotational subtrochanteric
osteotomy," The Journal of Bone & Joint Surgery (British Volume), vol.
 Proximal third femur includes head, neck, intertrochanteric region (between greater and lesser trochanter) and subtrochanteric
region (below lesser trochanter for about 5 cm).
Other treatment options are closed reduction, open reduction, heavy traction and abduction, subtrochanteric
osteotomy, Girdlestone arthroplasty, arthrodesis, endoprosthetic replacement and total hip replacement.3
Oh, "A computed tomography-based analysis of proximal femoral geometry for lateral impingement with two types of proximal femoral nail anterotation in subtrochanteric
fractures," Injury, vol.
The investigators identified the 1,234 cases of femoral subtrochanteric
and shaft fractures among older women that resulted from falls.
Another manufacturer-sponsored study showed that subtrochanteric
femur fractures have occurred in people who have not used bisphosphonates (Osteoporos.
(2) In 2007, Goh and colleagues reported 13 subtrochanteric
fractures, nine of which occurred in patients treated with alendronate.
Of this cohort, 167 (40.9%) sustained femoral neck fractures (31-B), 214 (52.5%) intertrochanteric fractures (31-A), and 27 (6.6%) subtrochanteric
fractures (32-A(1-3).1, 32-B(1-3).1, 32-C(1-3).1).
Femoral length was reconstructed using subtrochanteric
transverse diameter, vertical and transverse head diameter in a study by Jubilant  et al.
(22) The most common side effects include gastrointestinal disturbance, acute phase response, renal impairment, hypocalcemia, atrial fibrillation, osteonecrosis of the jaw (ONJ), and atypical subtrochanteric
femoral fractures (AFF).
Fractures of this nature commonly occur in the femoral shaft or subtrochanteric
region but rarely occur in the upper extremities .