Intertrochanteric Hip Fracture IMHS Technique Valgus angulation: place bone hook around neck to gain reduction.Apex anterior angulation on lateral view: use ball spike placed through anterior stab incision to push femoral neck.Must ensure bone is removed to allow room for nail or the nail with displace the fracture when inserted. Ensure guide pin is placed into bone on the trochanter.Intertrochanteric Hip Fracture Reduction Techniques Lateral view is generally best with rotation set around 65 degrees. Fluoro tips: AP image with machine approximately 15-20° over the top of the patient generally demonstrates the outline of the greater trochanter, and aids in visualization of the starting point for the nail.Consider subfascial transexamic acid injection to reduce peri-operative transfusion requirements by 43%.Stryker Gamma Nail (less fixation in the head, less time consuming).Smith & Nephew Trigen Intertan (provides solid fixation in the head, more time consuming).Intertrochanteric Hip Fracture IMHS Pre-op Planning Intertrochanteric Hip Fracture IMHS Alternatives Intertrochanteric Hip Fracture IMHS Contraindications ![]() Impending / pathologic proximal femur fracture.Reverse obliquity intertrochanteric hip fractures.Unstable intertrochanteric hip fractures.Intertrochanteric Hip Fracture IMHS Indications Intertrochanteric Hip Fracture IMHS Anatomy Synonyms: Hip IMHS, intramedullary hip screw, gamma nail, trigen intertan nail
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