Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb draped freely to allow manipulation and access for both plating and nailing procedures.

Anatomical surgical approach:  A lateral approach to the distal femur was utilized. The incision extended along the lateral aspect of the thigh, allowing exposure of the distal femur. Subperiosteal dissection was performed to expose the fracture site. Reduction was achieved using a distractor and clamps, followed by fixation with a combination of lateral plating and intramedullary nailing.

The surgeon noted that regaining length was challenging, requiring maximal use of a distractor and clamping techniques. The plate-nail combination was chosen to provide medial and lateral column stability, promoting healing through endochondral ossification. This construct was preferred due to the patient's obesity, which necessitated a robust fixation method.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with weight-bearing as tolerated to encourage healing through controlled mechanical loading.

Follow up:   Not specified.

Orthopaedic implants used:   Lateral distal femoral locking plate, intramedullary nail.