Intramedullary nailing of trochanteric fractures—Operative technical tips

Results of sagittaly unstable intertrochanteric fractures managed by dual reduction technique

“…7,8,11,16 Few authors have described the use of hohman retractor or bennet retractor introduced through incison of lag screw and placed under posterior sag and elevating it upwards. 7,9,10 We too, in our case series noticed such unusual fracture pattern and did not have any episode of slippage of crutch requiring additional assistant. In all our cases, surgery was carried by the chief surgeon and an assistant.…”

“…some authors use a mallet or a hohman retractor via the same incision as for lag screw to lift the distal sagging fragment but we observed that it requires an assistant who has to use sustained force till the insertion of nail and the lag screw to hold the reduction which can be tiring and frustrating for the assistant. 6,7,9,10 So the use of crutches avoids such problem. After reduction is achieved, nailing is carried out in routine manner.…”

“…7,8 Some authors have described the use of Hohman retractor or Bennet retractor introduced through incision of lag screw and placed under posterior sag and elevating it upwards. 7,9,10 Sometimes the posterior sag is the manifestation of overriding of proximal and distal cortices which requires open reduction. 11 Open reduction requires longer surgical time, more blood loss which can lead to delay in rehabilitation and sometimes wound problems.…”

Reply to Letter to the Editor: Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

“…It is true that there are numerous cases where defining the exact position of the awl at the tip of the greater trochanter is not reliable [1,2]. We agree that potential problems such as a stiff spine, soft tissue mass about the hip, operative drapes, or laterally oriented operating trajectory of the side-standing surgeon could arise, as Tao et al noted.…”

Letter to the Editor: Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

“…However, there are several reasons that make this unachievable in some patients [1,2]. In addition to morphologic features of the fracture (some can be reduced only with the hip in abduction) and a stiff spine in geriatric patients, the soft tissue mass about the hip, operative drapes, or a laterally oriented operating trajectory of the side-standing surgeon can result in a shift of the ideal trochanteric tip entry point and gradual enlargement in a lateral direction.…”