Strategies for Pertrochanteric Fracture Reduction and Intramedullary Nail Placement

Technical Tips and Tricks

Christopher Lee, MD; Ben Kelley, MD; Ajay Gurbani, MD; Alexandra I. Stavrakis, MD


J Am Acad Orthop Surg. 2022;30(18):867-878. 

In This Article

Abstract and Introduction


The incidence of pertrochanteric hip fractures continues to rise as the aging population expands. Despite advancements in techniques and implants, failure rates remain up to 16% in the literature. The recognition of challenging fracture patterns and the use of meticulous preoperative planning can help to avoid common pitfalls. Understanding fluoroscopic views for reduction assessment and implant placement is instrumental in preventing fixation failure. In addition, adjunctive techniques including the use of a bone hook, cerclage wire, and colinear clamps can facilitate reduction efforts. It is imperative for the surgeon to recognize common pitfalls and to consider a wide array of techniques to manage these challenging and common fractures.


Pertrochanteric hip fractures are common orthopaedic injuries that carry notable morbidity to patients and cost to healthcare systems.[1] The incidence of hip fractures has grown to 1.5 million adults worldwide per year.[2] Surgical fixation is the mainstay of care, and mortality benefits have been reported from surgery done within 48 hours of injury.[3] Despite advances in implant design and minimally invasive techniques, rates of failure remain as high as 9% to 16%.[4] Although the risk of failure is multifactorial, optimizing surgeon-related factors including reduction quality and implant placement is essential to improve outcomes.

Fracture fixation failure of hip fractures can have notable effects on patient morbidity and mortality. These failures often result in profound functional deficits and require revision surgery for revision fixation or arthroplasty.[5] The purpose of this article was to review technical tips and common pitfalls in the surgical treatment of pertrochanteric hip fractures.