Intertrochanteric Hip Fracture: Cephalomedullary Nail

Fixation of an intertrochanteric hip fracture with a nail down the femoral canal and a lag screw or blade into the femoral head, on a fracture table under fluoroscopy. The reduction is done before the prep; the rest of the case follows the guide wires.

Position and prep

Supine on a fracture table with a padded perineal post; injured leg in traction; well leg in a holder or scissored down; C-arm between the legs.

Prep: Hip, flank and thigh on the injured side, after the reduction is confirmed on images.

Room setup

Fracture table, padded post, traction boot, well-leg holder
C-arm and lead for everyone in the room
Power reamer and drill (tested, batteries fresh)
Nail system sets: nails, insertion jig, reamers, guide wires, lag screw or blade instruments
Isolation (shower-curtain) drape or U-drapes per surgeon

Implants

Cephalomedullary nail: short or long, with the diameter and neck-shaft angle the surgeon chooses
Lag screw or helical blade, with its set screw
Distal locking screw(s) per surgeon
End cap per surgeon

Instruments

Nail system instruments: entry awl or entry reamer, insertion handle and jig, aiming arm, measuring devices
Guide pins and ball-tipped guide wire
Flexible reamers (long nails)
Mallet
Cobb elevator, Hohmann retractors
Gelpi or Weitlaner retractors
Basic orthopedic tray for the soft tissue

In the free instrument guide: Hohmann retractor, Cobb elevator, Gelpi retractor, Weitlaner Retractor, Orthopedic mallet, Drill.

How the case runs

Time-out, including laterality, before traction is set; post and pressure points padded
Reduction under traction and rotation; images AP and lateral until the surgeon accepts it
Prep and drape
Incision above the tip of the greater trochanter

The rest of the case is in the app

7 more steps, the Mayo setup, draping order, closing, pearls, and a three-stage “what would you do next?” case. Free to start.

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Clinically reviewed by William Guglielmo on October 15, 2026. Generic teaching content. Your surgeon's preference card, the implant system's technique guide and facility policy always come first.