Avoiding varus malreduction during cephalomedullary nailing of intertrochanteric hip fractures

We describe a technique for preventing varus malreduction of intertrochanteric hip fractures during fixation with a cephalomedullary nail. When the entry reamer guidewire is positioned in the fracture line, passage of the entry reamer may simply push the proximal fragment medially and the distal fragment laterally rather than ream the accurate entry path. Subsequent nail insertion will result in a varus deformity of the proximal femur. The simple technique described in this report uses a brief period of over-distraction to wedge the entry reamer guidewire against the lateral edge of the proximal fragment, permitting the reamer to cut a correct path in the lateral edge of the proximal fragment. Creation of a proper entry path is essential to maintain anatomic reduction during cephalomedullary nailing of intertrochanteric hip fractures.