Technical TrickPreventing Wedge Deformities When Treating Intertrochanteric Femur Fractures With Intramedullary Devices A Technical TipButler, Bennet A. MD*; Selley, Ryan S. MD*; Summers, Hobie D. MD†; Stover, Michael D. MD*Author Information *Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL; and †Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL. Reprints: Michael D. Stover, MD, Department of Orthopedic Surgery, Northwestern Memorial Hospital, 676 North St, Clair St, Suite 1350 Chicago, IL 60661 (e-mail: Michael.firstname.lastname@example.org). The authors report no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com). Accepted September 15, 2017 Journal of Orthopaedic Trauma: March 2018 - Volume 32 - Issue 3 - p e112-e116 doi: 10.1097/BOT.0000000000001033 Buy SDC Metrics Abstract Summary: Intertrochanteric femur fractures are common injuries associated with significant patient morbidity and mortality and high societal costs. Although intramedullary devices have shown promises for treating a wide range of intertrochanteric femur fractures, improper technique can lead to malalignment, fracture displacement, and/or iatrogenic fractures. In particular, a “wedge effect” has been described, in which the passage of conical reamers and the intramedullary nail itself results in the distraction of intertrochanteric fragments with lateralization of the shaft from the femoral neck and varus malalignment. Here, we describe the mechanism by which this deformity is generated and describe techniques for preventing it, including the use of a modified starting point and an alternative to the conical opening reamers. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.