Technical TrickMedialized Trochanteric Entry Nailing Is a Safe and Effective Method for High-Energy Subtrochanteric Femur Fracture TreatmentNakken, Erik R. BS, BA*; Achor, Timothy S. MD†; Berkes, Marschall B. MD* Author Information *Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO; and †Department of Orthopaedic Surgery, University of Texas Health Sciences 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: [email protected]). The authors report no conflict of interest. No source of funding to report. 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). Journal of Orthopaedic Trauma: December 2022 - Volume 36 - Issue 12 - p 458-462 doi: 10.1097/BOT.0000000000002418 Buy SDC Metrics Abstract Summary: Fixation of subtrochanteric femur fractures using intramedullary nails can provide high rates of osseous union. However, a lateral starting point or a medial trajectory can result in varus alignment, typically seen with trochanteric entry nails. Even with piriformis nails, medial comminution can result in secondary malalignment and varus. Varus can predictably result in nonunion and need for repeat operations. Medialized trochanteric entry nailing has been reported previously as a method to prevent varus alignment in low-energy, atypical subtrochanteric femur fractures in association with bisphosphonate use. We present a surgical technique using a medialized trochanteric nail entry point to provide proper alignment and avoidance of varus malreduction in 24 patients with a subtrochanteric femur fracture after a high-energy traumatic event. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.