Temporary Reduction Assisting Corridor Constraint Wires (TRACC-wires) for Intramedullary Nailing of Periarticular Fractures: A Technical Trick and Case Series.

Abstract

Summary: Achieving satisfactory alignment during intramedullary nailing of periarticular fractures can be technically challenging due to a combination of deforming forces and the lack of cortical contact by the nail in the articular segment metaphysis allowing malreduction to persist during nail passage. Although blocking screws are described to facilitate reduction, they risk impeding subsequent implant fixation. This article introduces an innovative Temporary Reduction Assisting Corridor Constraint Wires (TRACC-wires) technique to safely correct multiplanar deformities without limiting fixation options. A retrospective case series of 22 patients showed that TRACC-wires effectively facilitated anatomic alignment intraoperatively that was maintained after wire removal. Compared with other methods, advantages include (1) the ability to easily redirect, reposition, or remove (given instant access to the blocking device), (2) malleability of the wires during nail insertion, (3) small bony footprint, and (4) versatility for patient-specific correction. Outcomes support TRACC-wires as a valuable tool for trauma surgeons managing complex periarticular fractures.