Fig. 3

Schematic Diagram of surgical procedure (long proximal femoral nail antirotation with lateral notching and dynamization). (A) Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association 31-A2 trochanteric fracture treated with proximal femoral nail antirotation, showing acceptable fracture reduction, helical blade position, and fracture gap. (B) Illustration shows nail breakage at the proximal aperture of the proximal femoral nail antirotation blade with trochanteric fracture nonunion due to fracture gap. (C) In cases where resistance was encountered, it was due to varus deformity caused by nail breakage. To address this, traction of the lower limb using the fracture bed was performed until resistance was eliminated, allowing the restoration of the same cephalo-diaphyseal angle as the old proximal femoral nail antirotation (D) long proximal femoral nail antirotation with lateral notching and distal screw dynamization and helical blade re-insertion at the same position of femoral head (center-center). (E) compressed fracture site and distal screw dynamization. (F) fracture is healed completely without a fracture gap