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Preventing Wedge Deformities When Treating Intertrochanteric Femur Fractures With Intramedullary Devices: A Technical Tip

Butler, Bennet, A., MD*; Selley, Ryan, S., MD*; Summers, Hobie, D., MD; Stover, Michael, D., MD*

doi: 10.1097/BOT.0000000000001033
Technical Trick

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.

*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:

The authors report no conflict of interest.

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Accepted September 15, 2017

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