Reverse Obliquity Intertrochanteric Hip Fractures: A Technique Guide for Using a Blocking Screw to Enhance Fixation

Reverse oblique (RO) intertrochanteric (IT) femur fractures are an unstable fracture variant because of loss of lateral-wall support, making cephalomedullary nail (CMN) fixation the preferred implant strategy for these fractures. Despite the biomechanical advantages of CMNs, lateral migration of the nail within the canal may permit fracture shear during weight-bearing and contribute to loss of reduction or fixation failure. The technique discussed in this article describes using a blocking screw in RO IT hip fractures to limit potential lateralization of the nail in the distal aspect of the proximal femoral canal and neutralize this shear tendency. The screw is placed adjacent to the intramedullary nail to support maintenance of reduction and alignment. This technical guide describes the operative steps and considerations for selective use of the screw; it does not present clinical or biomechanical outcome data. Further study is needed to determine its effect on fracture healing and fixation stability.