Elsevier

Injury

Volume 45, Issue 6, June 2014, Pages 1006-1010
Injury

Technical Note
Hook leverage technique for reduction of intertrochanteric fracture

https://doi.org/10.1016/j.injury.2014.02.007Get rights and content

Introduction

An intramedullary nail has become the implant of choice for today's orthopaedic surgeon for intertrochanteric fractures [1], [2].

Fixation failure or severe complications such as cut-out and cut-through result if accurate anatomical reduction is not achieved during surgery (Fig. 1) [3]. Although longitudinal traction and internal rotation of the fractured extremity will result in acceptable closed reduction of most intertrochanteric fractures, specific patterns of intertrochanteric fractures need percutaneous procedures, and some may even need open reduction [4], [5], [6]. Carr [4] defined a fracture pattern that needed a percutaneous procedure to achieve anatomical reduction. In this fracture pattern, the distal femoral shaft piece shortens and falls into external rotation, the proximal head and neck piece is displaced into a varus deformity and commonly translates posteriorly into the comminuted intertrochanteric region, and this fragment is engaged into the distal shaft piece. Accurate reduction of this particular fracture pattern is achieved with ease on the anteroposterior (AP) view during closed reduction, but there is a persistent disruption of the anterior cortex on the lateral view, which has to be manipulated into position (Fig. 2). Here we propose an ingenious way to overcome this problem and achieve anatomical reduction through a hook leverage technique as explained below.

Section snippets

Patients and methods

From our hospital database, we retrospectively collected 8 of 78 cases of intertrochanteric fracture reduced by percutaneous reduction and treated with intramedullary nail fixation between February 2010 and June 2013. All cases had a certain fracture pattern as described in Section 1 and were reduced using the percutaneous hook leverage technique with a bone hook. Patients with a minimum follow-up of 6 weeks were admitted into our study. There were 3 male and 5 female patients with an average

Results

A good reduction could be achieved with only closed reduction in one case. We had six acceptable reductions and one poor reduction before using the hook leverage technique. After performing the hook leverage technique, we could achieve a good reduction with adequate cortical contact in all cases before nail insertion, and we had a good reduction in five cases and an acceptable outcome with at least one cortical contact in three cases on immediate postoperative radiographs. No case had a poor

Discussion

Anatomical reduction is an important factor in surgeries for inter-trochanteric fracture [8], [9]. The goal of perfect reduction is made difficult by the fact that approximately 75% of these fractures are unstable [8]. Numerous techniques for the reduction of complex patterns of inter-trochanteric fractures have already been described; however, we require specific techniques to tackle certain fracture patterns. For example, Chun et al. [6] stated that the fracture pattern with a sagittal

Conclusion

Reduction, among the many factors related to complications and fixation failure, is a factor that is under the surgeon's control [18]. A poor anatomical reduction is related to a higher incidence of complications after surgery for the same severity of fracture [11]. Therefore, anatomical reduction should always be achieved in inter-trochanteric fractures, and every reduction technique is invaluable to an operating surgeon during his struggle to achieve the perfect reduction. We expect that our

Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. The authors declare no conflict of interest.

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