An intramedullary nail has become the implant of choice for today's orthopaedic surgeon for intertrochanteric fractures [1,2].Fixation failure or severe complications such as cut-out and cut-through result if accurate anatomical reduction is not achieved during surgery (Fig. 1) [3]. Although longitudinal traction and internal rotation of the fractured extremity will result in acceptable closed reduction of most intertrochanteric fractures, specific patterns of intertrochanteric fractures need percutaneous procedures, and some may even need open reduction [4-6]. Carr [4] defined a fracture pattern that needed a percutaneous procedure to achieve anatomical reduction. In this fracture pattern, the distal femoral shaft piece shortens and falls into external rotation, the proximal head and neck piece is displaced into a varus deformity and commonly translates posteriorly into the comminuted intertrochanteric region, and this fragment is engaged into the distal shaft piece. Accurate reduction of this particular fracture pattern is achieved with ease on the anteroposterior (AP) view during closed reduction, but there is a persistent disruption of the anterior cortex on the lateral view, which has to be manipulated into position (Fig. 2). Here we propose an ingenious way to overcome this problem and achieve anatomical reduction through a hook leverage technique as explained below.
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