Preventive fixation of the greater trochanter in the intramedullary nail for unstable pertrochanteric fractures of the femur: Xander’s technique - 26/03/25

Doi : 10.1016/j.otsr.2025.104233

Simone Verzellotti ^a,^{^{1
These authors contributed equally to this article.}}, Lorenzo Massimo Oldrini ^a,^{^{1
These authors contributed equally to this article.},}⁎ , Axel Gamulin ^c, Alberto Mameli ^a, Jochen Müller ^a, Marco Delcogliano ^a,^b
^a Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
^b Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
^c Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205 Geneva, Switzerland

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 26 March 2025

Abstract

Introduction

Proximal femoral fractures (PFF) represent a global public health burden as more than 10 million cases per year are globally reported. Kyle 3 and 4 or AO/OTA 31.A2 pertrochanteric fractures account for 10–15% of all PFF. This specific fracture pattern is characterized by intrinsic mechanical instability as a result of the presence of a detached greater trochanter fragment and is usually treated using a cephalomedulary nail (CMN). However, the unstable greater trochanter fragment makes the insertion of the CMN guide wire challenging.

Hypothesis

The aim of this surgical technical note is to describe this procedure basically allowing fracture simplification from unstable to stable, so that this complex PFF pattern can be approached in a structured manner with predictable results in terms of fracture reduction quality and implant position accuracy, even by junior surgeons.

Material and methods

We used this greater trochanter stabilization technique in 34 pertrochanteric fracture fixations with a CMN. Fracture union was achieved in all cases by a minimum one-year follow-up period without surgical complications.

Discussion

The authors developped a surgical technique allowing for both stable greater trochanter fragment stabilization and easier CMN guide wire insertion to avoid fracture dislocation and fragment collapse.