The treatment of subtrochanteric fractures is challenging due to the tendency toward varus, flexion deformity, and external rotation of the proximal fragment. This training presents, in a direct manner, the surgical management using an intramedullary nail with a minimally invasive technique, demonstrated in 4K video under a surgical perspective, with a focus on percutaneous reduction, biomechanical control, and adequate stability.

Training Focus

• Minimally invasive reduction of subtrochanteric fracture
• Control of flexion and rotation of the proximal fragment
• Entry point and guidewire parallelism
• Use of joystick, clamps, and percutaneous maneuvers
• Varus control during nail insertion
• Application of the poller screw
• Proximal fixation and distal locking

Detailed Content

• Controlled Percutaneous Reduction: Application of the seesaw maneuver with a Mixter clamp, use of a percutaneous joystick, and association with limb positioning to correct flexion and external rotation.
• Spatial Planning and Strategic Portals: Marking of the fracture site, longitudinal axis, and precise definition of mini-portals for safe manipulation of the proximal fragment.
• Optimized Entry Point for the Intramedullary Nail: Definition of the point slightly medial to the apex of the greater trochanter, with continuous correction in anteroposterior and lateral views.
• Guidewire Parallelism to the Medullary Canal: Practical demonstration of the use of the parallelism guide to avoid oblique entry and prevent residual malalignment.
• Varus Control in Subtrochanteric Fractures: Intraoperative strategies for correction of residual varus, including selective enlargement of the entry point and application of the medial poller screw.
• Rational Use of the Poller Screw: Indication, percutaneous positioning, and biomechanical effect of the poller in neutralizing deforming forces.
• Proximal Fixation and Distal Stability: Insertion of the sliding screw and use of two distal locking screws to reduce the windshield-wiper effect and increase stability within the medullary canal.
• Minimally Invasive Technique and Functional Recovery: Procedure with small portals, less tissue aggression, reduction of postoperative pain, and early release for gait training.

Included Material

The PDF objectively accompanies the complete surgical sequence of the training, including principles of percutaneous reduction, choice of the entry point, control of parallelism, management of varus, indication of the poller screw, and strategies for proximal and distal stability, with a focus on practical application in subtrochanteric fractures.

Improve your decision-making and technical execution in the treatment of subtrochanteric fractures. Enroll and master minimally invasive reduction with precise biomechanical control.