Preventing eccentric reaming of the trochanter during trochanteric nailing

The lateralizing vector of a flexible guide wire can result in eccentric lateral reaming of the proximal femur during intramedullary nailing procedures. This effect is especially true with peritrochanteric fractures that have a fracture line exit near the entry point, and in obese patients. We present one method of maintaining a co-axial position of the guide wire and reamer assembly to help direct the portal of reaming in a more anatomic position. Use of a concave shaped retractor such as an Appendiceal or Richardson helps to "capture" the reamer shaft and control where proximal reaming occurs. We have found this method to be easy to use and effective when indicated.