title: Clamp-assisted reduction of high subtrochanteric fractures of the femur: surgical technique.
abstract: BACKGROUND
  Subtrochanteric fractures can be a treatment challenge. The substantial forces that this region experiences and the fact that the proximal fragment is frequently displaced make accurate reduction and internal fixation difficult. The purpose of this study was to evaluate a series of patients who had undergone clamp-assisted reduction and intramedullary nail fixation to determine the impact of this technique on fracture union rates and reduction quality.
  
  
  METHODS
  Between December 2003 and January 2007, fifty-five consecutive patients with a displaced high subtrochanteric femoral fracture were treated with clamp-assisted reduction and intramedullary nail fixation at two level-I trauma centers. Two patients died, and nine were lost to follow-up. The remaining forty-four patients were followed until union or a minimum of six months. There were twenty-seven male and seventeen female patients with a mean age of fifty-five years. All were treated with an antegrade statically locked nail implanted with a reaming technique as well as the assistance of a reduction clamp placed through a small lateral incision. Nine patients were treated with a single supplemental cerclage cable. Radiographs were evaluated for the quality of the reduction and fracture union.
  
  
  RESULTS
  Forty-three of the forty-four fractures united. All reductions were within 5° of the anatomic position in both the frontal and the sagittal plane. Thirty-eight (86%) of the forty-four reductions were anatomic. Six fractures had a minor varus deformity of the proximal fragment (between 2° and 5°). There were no complications.
  
  
  CONCLUSIONS
  Surgical treatment of subtrochanteric femoral fractures with clamp-assisted reduction and intramedullary nail fixation techniques with judicious use of a cerclage cable can result in excellent reductions and a high union rate. Careful attention to detail is important to perform these maneuvers with minimal additional soft-tissue disruption.
authors.affiliation: Loma Linda University Medical Center, 11370 Anderson Street, Suite 1500, Loma Linda, CA 92354, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Afsari
authors.forename: Frank
authors.initials: F
authors.lastname: Liporace
authors.forename: Eric
authors.initials: E
authors.lastname: Lindvall
authors.forename: Anthony
authors.initials: A
authors.lastname: Infante
authors.forename: Henry C
authors.initials: HC
authors.lastname: Sagi
authors.forename: George J
authors.initials: GJ
authors.lastname: Haidukewych
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013525:Surgical Instruments; D016896:Treatment Outcome