Intramedullary Nailing of Subtrochanteric Femur Fractures.

Intramedullary nailing of subtrochanteric femur fractures may be a challenge because of the deforming muscle forces on the proximal fragment; the inability to attain an ideal starting point or fracture reduction; and the high risk for nonunion, malunion, and hardware failure as a result of the great amount of stress present in the subtrochanteric region of the femur. Surgeons should understand the surgical technique for and the outcomes of intramedullary nailing of subtrochanteric femur fractures. A proper starting point, maintenance of reduction during reaming, and careful consideration of femoral length and rotation are the keys to achieving good radiographic and clinical results.