Subtrochanteric fractures occur in the highest stress zone of the femur and present a unique surgical challenge due to the classic FEAR deformity. Master the biomechanics, Russell-Taylor classificationand the critical principle of reducing the fracture before reaming. ⏱ Chapters 0:00 Intro 0:21 Essentials 0:58 Fear 1:23 Russell Taylor 1:51 Seinsheimer 2:19 Biomechanics 2:52 Reduction 3:19 Algorithm 3:54 Atypical 4:27 Numbers 4:58 Clinical reasoning — Reduction 5:22 Clinical reasoning — Pearls This comprehensive orthopaedic masterclass provides an in-depth look at subtrochanteric femur fractures, exploring why they occur within five centimetres of the lesser trochanter and why powerful muscle forces cause the proximal fragment to displace. We cover the biomechanical reasons why intramedullary nails vastly outperform plates, how to utilise the Russell-Taylor and Seinsheimer classification systems to guide your surgical approachand the crucial steps for achieving and maintaining reduction using the BLOCKING mnemonic. 🦴 IN THIS VIDEO YOU'LL LEARN • Identify the unique anatomical and biomechanical properties of the subtrochanteric zone • Recognise the classic FEAR deformity (Flexed, Externally rotated, Abducted) caused by unopposed muscle pulls • Apply the Russell-Taylor classification to determine the correct nail entry point based on piriformis fossa integrity • Differentiate fracture stability and fragment patterns using the Seinsheimer classification • Understand why long cephalomedullary nails are the gold standard fixation compared to plates • Implement the critical surgical rule of confirming reduction on AP and lateral imaging before reaming • Utilise the BLOCKING mnemonic for surgical adjuncts including ball-spike pushers, cerclage wiresand blocking screws • Identify atypical bisphosphonate-associated fractures using the LATERAL BEAK criteria • Recognise the importance of accepting slight valgus alignment and preventing varus malunion ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ The nail follows the reamer: always achieve and confirm reduction before reaming to avoid locking in a malreduction. ✔️ Match the leg position to the proximal fragment by flexing, abductingand slightly externally rotating to overcome the FEAR deformity. ✔️ Always use a long cephalomedullary nail to share load, reduce the lever armand protect the entire femur from stress risers. ✔️ If the piriformis fossa is fractured (Russell-Taylor Type II), you must switch to a trochanteric entry nail. ✔️ Accept slight valgus and NEVER accept varus; use blocking (Poller) screws proactively in the concavity to guide nail trajectory. ✔️ Be vigilant for atypical fractures in patients with over five years of bisphosphonate use, looking for lateral cortex beaking. 👩⚕️ WHO THIS IS FOR This masterclass is designed for orthopaedic surgical trainees, medical students, junior doctorsand clinicians seeking a comprehensive understanding of lower limb trauma. Curious patients with a background in human biology will also find this detailed breakdown highly informative. 📚 RELATED TOPICS: Atypical Bisphosphonate Femur Fractures · Russell-Taylor Classification System · Cephalomedullary Nailing Technique · Blocking Screws (Poller Screws) in Intramedullary Nailing · Proximal Femoral Anatomy and Muscular Attachments · Femoral Shaft Stress Fractures 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #orthopedicsurgery #subtrochantericfracture #femurfracture #traumaorthopaedics #cephalomedullarynail #FEARdeformity #intramedullarynail #fracturefixation #orthoteaching #atypicalfracture #bonetrauma