Surgical Technique - The "Derriere View" for Evaluation of Guidewire Position in Cephalomedullary Nailing of Intertrochanteric Femur Fractures.

Intertrochanteric (IT) hip fractures are common in the elderly and are frequently treated with cephalomedullary nailing. Despite advances in implant design, fixation failure, such as cut-out or cut-through, remains a concern, often related to suboptimal implant positioning and limited intraoperative visualization of the femoral neck cortex. This technical report describes the Derriere view, an additional intraoperative fluoroscopic projection applied during cephalomedullary nailing of intertrochanteric fractures with the targeting jig and instrumentation in situ. The view is obtained by rotating the C-arm approximately 40° cranially from the standard lateral position and is intended to provide additional visualization of the posterior femoral neck cortex when this is inadequately delineated on conventional projections. The technique has been routinely used at our center as an adjunct to standard fluoroscopic views, particularly when conventional anteroposterior and lateral projections provide inadequate visualization of the posterior cortex. This additional projection may facilitate intraoperative identification of guidewires positioned close to the posterior cortex, allowing timely repositioning before definitive implant placement. It may be particularly useful in anatomically complex or comminuted fractures where reduction is suboptimal. The Derriere view is a simple adjunct to standard fluoroscopic imaging that may improve posterior cortical visualization during IT fracture fixation. Further prospective studies are required to determine its reproducibility, clinical effectiveness, and potential to reduce implant malposition and associated complications.