The Gotfried (Nonanatomic, Closed) Reduction of Unstable Subcapital Femoral Fractures

A nonanatomic reduction of displaced—unstable subcapital femoral fractures has been described. The rationale of this approach is based on biomechanical consideration. Definitions used in this method include: negative buttress—in which the lower medial edge of the proximal fracture part (femoral neck and head) is protruding medially to the upper medial edge of the distal femoral neck part; positive buttress—in which the upper medial edge of the distal femoral neck part is protruding medially to the distal medial edge of the proximal fracture part. Because observations have shown that negative buttress is associated with a higher failure rate of reduction, negative buttress should be avoided. Negative buttress allows easier displacement of the reduced femoral head into the varus; positive buttress acts in the opposite way. Hence, the goal of the Gotfried reduction is to create a positive buttress reduction while at the same time reduce the fracture in the valgus. With the patient positioned on a fracture table, the procedure includes 3 stages: (1) desimpaction; (2) reduction; and (3) reconstruction. The author uses this technique when preservation of the femoral head, after subcapital fractures, is desired.