Correction of malalignment in proximal femoral nailing--Reduction technique of displaced proximal fragment.

Abstract

External rotation, abduction, and flexion of the proximal fragment in proximal femoral fracture are one of the main obstacles in nailing. We introduced simple surgical technique using a long hemostatic forceps to achieve fracture reduction and to facilitate preparation of the nail entry site. Using this reduction method, 16 patients with displaced subtrochanteric or proximal femoral shaft fracture were treated through cephalomedullary or femoral nailing between January 2005 and May 2007. The difference of the neck-shaft angle in the AP view compared to the normal side was 2.2 degrees (range, 0-5 degrees). Anterior angulation in the lateral view was 1.6 degrees (range, 0-15 degrees). One case of malunion was caused by too anterior nail insertion in the lateral view. Bone union was achieved in all cases with an average consolidation time of 5.1 months (range, 3-9 months). A simple reduction technique using readily available instruments in the operating room (hemostatic forceps) is quite useful in reducing proximal femoral fragments in cephalomedullary or femoral nailing.