SUBTROCHANTERIC FRACTURE [Case 1] · Minimally Invasive Intramedullary Nail

The treatment of subtrochanteric fractures is challenging due to the tendency towards varus, flexion deformity, and external rotation of the proximal fragment. This training directly presents surgical management with an intramedullary nail using a minimally invasive technique, demonstrated in a 4K video from a surgical perspective, focusing on percutaneous reduction, biomechanical control, and adequate stability.

Training Focus

• Minimally invasive reduction of subtrochanteric fracture
• Control of flexion and rotation of the proximal fragment
• Entry point and guidewire parallelism
• Use of joystick, clamps, and percutaneous maneuvers
• Control of varus during nail insertion
• Application of the Poller screw
• Proximal fixation and distal locking

Detailed Content

• Controlled Percutaneous Reduction: Application of the seesaw maneuver with Mixter clamp, use of percutaneous joystick, and association with limb positioning to correct flexion and external rotation.
• Spatial Planning and Strategic Portals: Marking the fracture focus, longitudinal axis, and precise definition of mini-portals for safe action on the proximal fragment.
• Optimized Intramedullary Nail Entry Point: Definition of the point slightly medial to the apex of the greater trochanter, with continuous correction in anteroposterior and lateral views.
• Guidewire Parallelism to the Medullary Canal: Practical demonstration of using the parallelism guide to avoid oblique entry and prevent residual deviations.
• Varus Control in Subtrochanteric Fractures: Intraoperative strategies for correcting residual varus, including selective widening of the entry and application of the medial Poller screw.
• Rational Use of the Poller Screw: Indication, percutaneous positioning, and biomechanical effect of the Poller in neutralizing deforming forces.
• Proximal Fixation and Distal Stability: Insertion of the sliding screw and use of two distal locks to reduce the windshield wiper effect and increase stability in the medullary canal.
• Minimally Invasive Technique and Functional Recovery: Procedure with small portals, less tissue aggression, reduced postoperative pain, and early release for gait training.

Included Material

The PDF objectively follows the complete surgical sequence of the training, including principles of percutaneous reduction, entry point selection, parallelism control, varus management, Poller screw indication, and strategies for proximal and distal stability, with a focus on practical application in subtrochanteric fractures.

Improve your decision-making and technical execution in the treatment of subtrochanteric fractures. Enroll and master minimally invasive reduction with precise biomechanical control.