Surgical Discussion

Patient positioning:  The patient was positioned supine on a standard operating table, with the affected limb prepared for open reduction and internal fixation without the use of a traction table.

Anatomical surgical approach:  A Heuter approach was utilized, involving an incision over the anterior aspect of the hip, allowing direct access to the femoral neck for anatomical reduction. The approach facilitated visualization and reduction of the vertical neck fracture. The pertrochanteric region was addressed through the same incision, ensuring adequate exposure for intramedullary nailing.

The surgeon emphasized the complexity of achieving simultaneous reductions of both fractures. Stout wires were employed to secure the reductions, placed anteriorly and posteriorly to the anticipated nail path. Due to the absence of calcar support, a strong biocomposite material was used to fill the gap and resist varus collapse. The choice of implants was critical, with a fixed angle device for the neck and an intramedullary nail for the pertrochanteric fracture.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing on the affected limb for six weeks, followed by progressive weight bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Fixed angle implant for femoral neck, intramedullary nail for pertrochanteric fracture, stout wires, biocomposite material.