Pertrochanteric fractures: tips and tricks in nail osteosynthesis

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Intramedullary fixation is the standard for unstable intertrochanteric fractures, particularly in elderly patients.
• While implant technology has advanced, surgical technique remains critical for successful outcomes.
• Nailing offers advantages like a short lever arm but can make closed reduction challenging.

Purpose of the Study:

• To emphasize the paramount importance of surgical technique in intramedullary fixation of intertrochanteric fractures.
• To highlight key technical aspects for achieving and maintaining anatomic reduction and stable fixation.
• To underscore that optimal implant positioning is crucial for preventing complications like cut-out and non-union.

Main Methods:

• Focus on patient positioning, accurate fracture reduction, and appropriate nail entry point selection.
• Emphasize precise lag screw placement within the head-neck fragment and secure distal locking.
• Discuss strategies for maintaining reduction, such as cerclage wiring or managing fracture gaps, and the role of intraoperative compression.

Main Results:

• Anatomical reduction and perfect implant positioning are essential for successful intramedullary fixation.
• Deficient surgical techniques can negate advancements in implant design.
• Proper technique facilitates immediate full weight-bearing without increased risk of complications.

Conclusions:

• Surgical approach and fixation technique are paramount for treating intertrochanteric fractures with intramedullary nails.
• Achieving anatomic reduction and optimal implant positioning is critical for preventing delayed unions, nonunions, and implant failure.
• Surgeons must prioritize meticulous technique over implant sophistication for optimal patient outcomes.