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Intramedullary Nailing of Subtrochanteric Femur Fracture

intermediate Level

Primary Indication

Subtrochanteric femur fracture (within 5cm of lesser trochanter)

Danger Structures

  • undefined - Variable based on approach
  • undefined - Surrounding operative field
  • undefined - Bone surface
  • undefined - Joint surfaces if applicable

Visual Atlas

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We're currently sourcing high-quality anatomy diagrams for this procedure.

Step-by-Step Technique

1

Closed reduction under fluoroscopy - often challenging

2

Flexion/external rotation deformity common - address with traction

3

Cephalomedullary nail with proximal locking

4

Piriformis entry: in line with femoral canal

5

Trochanteric entry: lateral wall of piriformis fossa

6

Insert ball-tip guide wire across fracture

7

Sequential reaming over guide wire

8

Insert appropriately sized nail

9

Proximal locking with lag screw (130° or 125°)

10

Distal static locking

11

Consider blocking/Poller screws for alignment

12

Verify TAD <25mm, tip-apex distance