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General considerations

In more proximal fractures, due to the pull of the iliopsoas muscle, the upper main fragment may be flexed and externally rotated, and the distal segment lies posteriorly due to gravity.

Reduction is performed under image intensification.

Several options for fracture reduction can be considered:

  • Elevation of the distal fragment by use of a crutch.
  • Lowering of the proximal fragment by external pressure from a mallet.
  • A wrap around the femur.
  • A Schanz screw inserted into one of the fragments.
  • Use of a bone hook.
  • (Manual reduction)
  • Poller screws