Traction release in trochanteric (I/T) fracture nailining: WHEN & HOW MUCH?

[@indroneilbhaduri1]

wonderful

[@amitbisht624]

Amazing concepts thnx🎉

[@akramtaha8244]

Excellent 👍🌷

[@raghuvaran6081]

Excellent sir

[@kevinpaulsebastian3938]

Nice explanation

[@MohammedAlkhazem]

Thank you

[@saurabhchandra6267]

Very good work. Keep it up. I have a question. Seniors in my college are used to releasing gross traction before compression. What happens then is that sometimes shaft goes into the proximal fragment. So should be release traction gradually by releasing fine traction and giving compression simultaneously or should we release gross traction at once? Thank you

[@Justorthothings]

Thanks! See, as I told in the video, once you have inserted the screw, the excess traction is of no use. You can release the traction gradually so that muscle tension is relaxed. The compression actually pulls the shaft towards the proximal fragment in a direction parallel to the direction of the screw/or blade. If your reduction is positive and medial spikes (calcar ends) are at the same horizontal level, then after placing the screw, the excess release of traction won't be an issue. Problems can occur when there is a wedge effect or when the guide wire is inserted in a distracted position.

[@srinivasaraosirasapalli5104]

Nice

[@aastiw2721]

Releasing the traction twice means? Do we again increase the traction after placing the guide wire in head or traction is loosened and further loosening during screw tightening?

[@Justorthothings]

No, once guidewire has been put, no traction should be increased. See releasing traction at the first time is to align the medial cortex levels and is thus can be controlled, the second time its for relaxing muscle tension which will be perceived as the difficulty in gaining compression. As I have shown in second example, the amount of traction release can be negligible at times when medial cortex spikes are at same level even if fracture is slightly distracted. So, you have the indicators (medial cortex levels and force for compression) for sequential release of traction at two steps and the amount will vary from case to case.

[@vinhphaminh7007]

2 time release, first before pinning in head, the second before compression is right? The first release may be loss reduction ?

[@Justorthothings]

Release of first traction is calibrated fluroscopically, you just need to ensure that fracture is not distracted and will remain positive cortex after compression. The proximal hohmann will take care of flexion while loss of reduction in slight varus wont be an issue as you can correct that after nail insertion but before guidepin insertion by just abducting the limb/ again calibrating traction after nail insertion but before guidepin insertion/ using a pushing device to valgise head and in most case medial entry automatically corrects slight varus.

[@vinhphaminh7007]

One more thing Sir, if you get traction and ap , lateral c arm every on way, medial cortex is possitive so just release when compression is right? Thank you for your reply

[@Justorthothings]

@@vinhphaminh7007 yes, once compression right, traction won't be of any use.

[@parkaviyanr6397]

If I may ask where do you work and is it possible to know who are...or do you want to keep it private

[@Justorthothings]

Hi, Sorry, at this stage, I won't be able to make it public due to professional commitments, but maybe later I will.

[@jaganekorapala2949]

How to avoid proximal entry in to fracture line

[@Justorthothings]

See, in some fractures, you are invariably going to merge the nail entry with the fracture line, even if you don't intend to do so. The main thing is to avoid the wedge effect, even if your entry merges with the fracture line. See this video; you ll get it: kzbin.info/www/bejne/qmTPlquAhbB2obs