Clinical Details

Clinical and radiological findings:  Comminuted reverse subtroch fracture in a centarian. The fracture constellation looks so innocent on initial plain films, though you can appreciate the vertical split separating the GT from the intertrochanteric line. I think the true magnitude of the problem can be appreciate on the initial fluroscopic images (position on a traction table, images under traction). Reduction over ligamentotaxis achieve precisely nothing, and served only to demonstrate with more clarity the number of fragments. Transvastus approach to the fracture, open reduction with clamps, then provisional cerclage wiring, not tightened down, reforms the tube. Nail insertaion only after reduction - trying to reduce over a subobtimal nail insertion is a major headache.