This AAOS Instructional Course Lecture by Haidukewych distills ten technical tips for reducing complications in intertrochanteric hip fracture surgery. It covers fracture pattern recognition, device selection, reduction sequence, nail insertion mechanics, and implant placement. The guidance is drawn from the author's own case series and synthesis of the peer-reviewed literature available through 2009.
The 56% failure rate of sliding hip screws in reverse obliquity fractures is the number that changed practice. When you see a fracture line that runs from inferomedial to superolateral (or involves the lateral wall), a sliding hip screw will lateralize the proximal fragment — reach for a nail.
For any of the four unstable patterns (reverse obliquity, transtrochanteric, large posteromedial fragment, subtrochanteric extension), intramedullary nailing is the standard of care because osseous load-sharing cannot occur and the implant bears everything.
Two intraoperative habits flow directly from this paper: confirm TAD under 25 mm on both anteroposterior and lateral fluoroscopy before closing, and release traction before placing distal locking screws to prevent distraction nonunion.
This paper codified Baumgaertner's 1995 TAD concept into a surgical checklist and provided the four-pattern framework that now appears in every major trauma curriculum. Knowing these patterns cold is table stakes for the OITE.
This AAOS Instructional Course Lecture by Haidukewych distills ten technical tips for reducing complications in intertrochanteric hip fracture surgery. It covers fracture pattern recognition, device selection, reduction sequence, nail insertion mechanics, and implant placement. The guidance is drawn from the author's own case series and synthesis of the peer-reviewed literature available through 2009.
The 56% failure rate of sliding hip screws in reverse obliquity fractures is the number that changed practice. When you see a fracture line that runs from inferomedial to superolateral (or involves the lateral wall), a sliding hip screw will lateralize the proximal fragment — reach for a nail.
For any of the four unstable patterns (reverse obliquity, transtrochanteric, large posteromedial fragment, subtrochanteric extension), intramedullary nailing is the standard of care because osseous load-sharing cannot occur and the implant bears everything.
Two intraoperative habits flow directly from this paper: confirm TAD under 25 mm on both anteroposterior and lateral fluoroscopy before closing, and release traction before placing distal locking screws to prevent distraction nonunion.
This paper codified Baumgaertner's 1995 TAD concept into a surgical checklist and provided the four-pattern framework that now appears in every major trauma curriculum. Knowing these patterns cold is table stakes for the OITE.