For the intertrochanteric fracture, the best location to obtain anatomy stability is medially[8, 9]. However, the medial region is unable to provide stability in comminuted fractures, attempts to reduce the medial buttress are different, we can sometimes obtain the anatomy reduction with closed methods, other important techniques include Kirschner reduction, enlarge proximal incision, et, al. The one circumstance where these techniques won’t work is when there is locked in the medial region of the proximal femur.
The key factors for the successful treatment of intertrochanteric fractures in the elderly are obtaining stable medical support, rigid internal fixation, good reduction, and early mobilization[10, 11]. To achieve these goals, anatomic reduction of the medial area of intertrochanteric fractures was chosen as an important method. Few studies have offered surgical tips to reduce medial displacement during implanting helical blade. After several trial, the fracture could be reduced using a right-angle plier by a small auxiliary incision. Manipulating the right angle plier is required while installing a helical blade. Reduction was achieved in all cases. Although the fracture classifications are different, the fracture time could be reduced by avoiding repeated Steinmann’s pins inserted percutaneously and hesitation for closed reduction.
In most cases reduction could be achieved by close reduction with longitudinal traction and slight internal rotation due to fracture classification. However, several fracture patterns should need open reduction. Anterior lateral incision was suggested by Hockman, anterior lateral incision can be applied around the fracture to aid fracture reduction, however, long incision and more blood loss were disadvantages.
In our patients, we suggested a small direct lateral incision to expose the fracture and got anatomy reduction according to manipulating a right angle plier. Splitting tensor fasciae latae and vastus lateralis muscle could achieve fracture area safety, subperiosteal dissection is essential to avoid injury femoral artery and nerve.
Although this study was not prospective or randomized. Furthermore, too few patients were involved. A comparison was not designed because of unpredictable surgery. Despite these weak points, this study provided several useful results. The technique was performed only medially displaced occurred in AP view. By adding this simple technique (auxiliary incision technique), it may be possible to get an anatomic reduction in elderly patients with intertrochanteric fractures.