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Medialized Trochanteric Starting Point and Focused Lateral Endosteal Beak Reaming to Optimize Success of Intramedullary Nailing in Atypical Femur Fractures

A Technical Trick and Case Series

Berkes, Marschall B. MD*; Shaw, James C. MD; Warner, Stephen J. MD, PhD; Achor, Timothy S. MD

doi: 10.1097/BOT.0000000000001511
Technical Trick

Summary: Optimal intramedullary treatment of atypical femur fractures associated with bisphosphonate use requires avoidance of postoperative malreduction, particularly varus. This can be difficult to achieve, given the fracture location, errors with nail entry point, endosteal beaking, and underlying patient osteology, all of which can contribute to postoperative varus and predispose the patient to treatment failure. We present a surgical technique and clinical series of 10 patients emphasizing a medialized trochanteric nail entry point and preferential lateral endosteal reaming to secure a biologically and biomechanically favorable reduction and fixation.

*Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO;

Hospital for Special Surgery, New York, NY; and

Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.

Reprints: Marschall B. Berkes, MD, Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8233 St. Louis, MO 63110 (e-mail:

T. S. Achor: Depuy Synthes, Globus, Imagen Technologies, SMV Medical: consultant, AOTrauma North America: speaker. The remaining authors report no conflict of interest.

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Accepted April 25, 2019

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