Reduction Techniques for Trochantericand Subtrochanteric Fractures of the Femur: a Practical Guide

Trochanteric intramedullary nailing has gained widespread acceptance and popularity among orthopedic trauma surgeons. Whereas some simple fracture patterns are easily reduced and nailed, others may present a major challenge for the surgeon. Anatomical reduction and optimal placement of the intramedullary implants are the most important factors for fracture healing and good functional outcome. Closed anatomical reduction is to be achieved before the nail is inserted. However, especially in inter- and subtrochanteric fractures, a limited open or even open reduction technique may be necessary to achieve an adequate reduction. This article focuses on a structured and practical approach to various reduction techniques based on characteristic displacement patterns. The authors describe in detail their favored reduction techniques with tips and tricks for problem-solving. Furthermore, a non-systematic review of the current literature is provided with a critical appraisal of the described techniques and alternative methods. Key words: trochanteric, subtrochanteric femur, fracture, reduction, cephalomedullary nail.