{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:22:20Z","timestamp":1790774540538,"version":"4.1.0"},"reference-count":33,"publisher":"EDP Sciences","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":338,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SICOT-J"],"accepted":{"date-parts":[[2025,10,19]]},"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    : Subtrochanteric femur fractures present complex biomechanical and biological challenges with considerable variability in management approaches. Despite a structured approach to operative fixation using the intramedullary nail being accepted as the gold standard for most subtrochanteric fractures, a number of high-impact clinical dilemmas lack clarity and consensus on management approaches due to limited high-level clinical and published evidence.\n                    <jats:italic>Methodology<\/jats:italic>\n                    : We identified 11 key controversies through a comprehensive literature review of the PubMed, Scopus, and Cochrane databases from 2011 to 2024. Expert input through direct conversations with high-volume trauma surgeons further reinforced the selection of these problem statements. A modified Delphi consensus process was used to engage with 64 experienced Indian orthopedic surgeons. A four-phase methodology was employed, beginning with the pre-definition of 11 key controversies through literature review. PubMed\/Scopus\/Cochrane: 2000\u20132024 and expert input. Phase I description: Before initiating the consensus process, a steering committee systematically reviewed existing literature to predefine and shortlist 11 high-impact, unresolved clinical dilemmas. This ensured all subsequent phases of evidence synthesis and voting were focused on these predefined domains.\n                    <jats:italic>Results<\/jats:italic>\n                    : Eleven evidence-supported consensus statements were ratified, addressing implant selection, reduction techniques, technical nuances, and complex scenarios. All statements included clinical rationale, consensus strength (10 Strong, 1 Moderate), and evidence level (I\u2013III). Key outputs of the meeting were the formulation of a standardized treatment algorithm and a decision-making framework for ambiguous clinical situations.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : This consensus provides practical, expert-endorsed guidance to resolve recurring controversies in subtrochanteric fracture management. By bridging evidence gaps with collective surgical experience, it aims to standardize care, reduce unwarranted variation, and improve patient outcomes.\n                  <\/jats:p>","DOI":"10.1051\/sicotj\/2025060","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T08:57:38Z","timestamp":1764925058000},"page":"58","source":"Crossref","is-referenced-by-count":4,"title":["Consensus-based guidelines on subtrochanteric femur fractures: Bridging evidence and experience on 11 key clinical dilemmas"],"prefix":"10.1051","volume":"11","author":[{"given":"Swapnil","family":"Keny","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6821-0640","authenticated-orcid":false,"given":"Murali","family":"Poduval","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8683-6102","authenticated-orcid":false,"given":"Anjali","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-3485","authenticated-orcid":false,"given":"Vaibhav","family":"Bagaria","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"250","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.rbo.2015.04.031","volume":"51","author":"Barbosa de Toledo Louren\u00e7o","year":"2016","journal-title":"Revista Brasileira de Ortopedia"},{"key":"R2","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s00068-021-01834-6","volume":"48","author":"Panteli","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"R3","unstructured":"Medda S, Reeves RA, Pilson H (2025) Subtrochanteric femur fractures. 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