# Nail-Retaining Derotation Osteotomy for Subtrochanteric Fracture Malunion: A Case Report and Review of the Literature

## TL;DR

This paper presents a successful surgical technique to correct a rotational misalignment in a femoral fracture using an open osteotomy while retaining the original nail.

## Contribution

The novel contribution is the successful application of an open derotation osteotomy with nail retention for subtrochanteric fracture malunion.

## Key findings

- An open femoral osteotomy using a Gigli saw corrected a 30° internal rotation malunion.
- The original nail was retained during the procedure, avoiding the need for removal.
- The surgical approach yielded optimal clinical results in the presented case.

## Abstract

Rotational malalignment is relatively common after intramedullary nailing of femoral fractures and may lead to significant clinical symptoms. Comminution, inherent differences in femoral version, and the absence of reliable clinical markers make achieving anatomical rotational reduction challenging, even for experienced surgeons. Various methods have been described to surgically correct rotational deformities, depending on the time elapsed since the original surgery and whether the fracture has already united. Both open and closed techniques have been used, along with different types of osteosynthesis hardware. We present a case of a subtrochanteric fracture malreduction fixed in 30° of internal rotation, which was corrected through an open femoral osteotomy using a Gigli saw while retaining the original nail three months after the index operation. This operative approach yielded optimal results in our case.