A technique to support a fractured lateral wall in unstable intertrochanteric fractures.

1. The Lasso Technique in
Intertrochanteric fractures
George Thomas,
St.Isabel’s Hospital,
Chennai, India.

2. Intertrochanteric fractures with a thin lateral wall
are a challenge because the wall usually fractures
during reaming for insertion of the head screw.
The lack of a lateral support leads to the distal
fragment moving excessively medially as the
head screw slides laterally to a position of
stability.

3. Debates about this problem have centred on the best
implant to use in this situation.
Whether one uses a proximal femoral intramedullary
device, or an extramedullary device like the sliding hip
screw, the potential to fracture the lateral wall is high.
Securing the lateral wall should be the focus.

4. Female, 87 years.

5. AP and Lateral C arm
images after closed
reduction.
Note the void on the
anterior – medial side.
This gap has to be
closed to ensure
successful union.

6. Note the fracture in
the lateral wall at the
site of entry of the
head screw.

8. A cerclage wire is used
to hold the fragments
in place. The wire
tightener is used to
“lasso” the fragments
together. It is not
removed till the
reaming is over.

9. Lateral view showing
that the gap on the
anterior-medial
surface has been
closed by the lasso.

10. AP and Lateral views
on completion.
The gap on the
anterior – medial
surface has been
closed.
We now have a stable
fracture configuration.