Author's reply.

Sir,

We thank Kumar CY,1 for keen interest in our article.2 The reply to your each question is as follows.

We agree with the authors that these fractures are common in tertiary hospitals. Presentation of fractures in tertiary hospitals is not representative of the true incidence in the general population. Tip of the greater trochanter (GT) was the entry point for all our cases. We faced GT fractures in two cases. Careful graduated reaming prevented shattering of GT in the rest of the cases. Same nails of a single manufacturer (Yogeshwar Implants (I) Pvt Ltd, Mumbai, India) were used for all cases. We fixed distal locking first as a matter of routine surgical technique at our hospital, which is influenced by our experience of fixation with proximal femoral nail. Temporary stabilization by 3 mm K-wires to avoid displacement of the proximal nail fracture construct is done before hand. No open reduction was needed for intracapsular fractures because in the majority of cases the fractures were undisplaced or minimally displaced. However, in a displaced fracture after stabilization of the femur, it is easy to reduce the fracture. Union in malposition was avoided because of careful closed reduction and fixation in satisfactory position aided by the implant in situ. Proper execution of the method can avoid the potential complication of malunion. Change of angle by osteotomy with or without bone graft leads to union in nonunion neck femur. The inherent differences in fracture biology between nonunion neck femur and shaft fractures need to be considered.3 Primary grafting was not needed in our study.