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Intramedullary Nailing of a Subtrochanteric Femur Fracture: Piriformis Entry in the Lateral Position

March 01, 2017

Contributors: Todd Conlan, MD; Mark Hake, MD; Jacob Kirsch, MD; Jacob Kirsch, MD

Surgical management of subtrochanteric femur fractures in patients with multiple injuries is associated with several challenges because of concomitant injuries and various patient factors. Management of subtrochanteric femur fractures with the use of an intramedullary nail and the patient in the lateral decubitus position on a regular radiolucent surgical table with manual traction may be advantageous; however, it may be technically challenging. Various factors, such as optimal patient positioning, operating room setup, draping strategies, and an understanding of regional anatomy, are essential for successful management of subtrochanteric femur fractures. In addition, the technical aspects of obtaining an accurate starting point and fracture reduction are paramount. This video describes a safe and reproducible technique for the surgical management of subtrochanteric femur fractures via an intramedullary nail and a piriformis starting point in the lateral position. The advantages of and indications for this technique are discussed. In addition, the typical patient presentation, imaging findings, operating room setup, pertinent anatomy, and fracture reduction strategies are reviewed.