Surgical Discussion

Patient positioning:  The patient was positioned laterally to facilitate access to both the acetabulum and proximal femur. This positioning allowed for easier manipulation and reduction of the displaced fragments.

Anatomical surgical approach:  A Watson-Jones approach was utilized for the proximal femur, involving an incision over the lateral aspect of the hip, followed by dissection through the interval between the tensor fasciae latae and gluteus medius. Subperiosteal elevation was performed to expose the femoral head and neck for reduction.

The surgeon noted that closed reduction on a fracture table was not feasible due to the deforming forces on the fracture fragments. Open reduction was achieved using a GT hook plate for stabilization of the greater trochanter, followed by insertion of an antegrade reamed reconstruction nail starting at the "trochiformis" region. The choice of implants was critical to avoid high failure rates associated with proximal femoral locked plating or blade plates.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with crutches for 6 weeks, followed by gradual progression to full weight-bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   GT hook plate, antegrade reamed reconstruction nail.