Cephalomedullary Nailing of Pertrochanteric Femur Fractures using a Large Distractor and Standard Radiolucent Table

Background: Cephalomedullary nailing is used to treat pertrochanteric fractures of the femur. A fracture or traction table is generally used to obtain and maintain fracture reduction. Some patients because of body habitus or ipsilateral foot or ankle pathology are not well suited for standard fracture table use. This study describes a technique and the results of using the large distractor on a standard radiolucent table to treat pertrochanteric femur fractures with a cephalomedullary implant. Methods: The described technique was used to reduce and stabilize pertrochanteric femur fractures with a cephalomedullary implant. All fractures were reduced on a radiolucent table using the large bone distractor with 5 or 6 mm threaded pin in supra-acetabular area of the pelvis and a 5 mm threaded pin in the distal femur. Results for the first 36 patients treated with this technique are reviewed. Results: All fractures were able to be reduced and stabilized using the technique. The average total operative time was 89 minutes and the average time from incision to wound closure was 53 minutes. Thirty patients were followed until fracture union and healed without further surgical intervention. One patient developed a nonunion with implant failure, 4 patients died, and 1 was lost to follow up. Conclusions: Pertrochanteric femur fractures can be reduced and stabilized using this technique if the surgeon feels the fracture table is not a good option.