Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table to facilitate intraoperative imaging and access.

Anatomical surgical approach:  A direct anterior Heuter approach was utilized, involving an incision over the anterior aspect of the hip. Dissection proceeded through the interval between the sartorius and tensor fascia lata muscles, providing access to the hip joint capsule. Capsulotomy was performed to expose the femoral neck and head for reduction.

The surgeon noted the utility of a 2.5mm Schanz pin in the femoral head for manipulative reduction, combined with a straight modified Weber clamp for maintaining reduction. The anterior inferior 2.7mm reconstruction plate served as a buttress against varus collapse and functioned similarly to an anti-rotation screw, providing robust support during definitive fixation with a fixed angle device. The surgeon emphasized the importance of achieving an anatomic reduction over the timing of surgery for optimal outcomes.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with toe-touch weight bearing (TTWB) for 6 weeks, followed by progressive weight bearing as tolerated. Range of motion exercises were initiated immediately post-surgery to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   2.5mm Schanz pin, 2.7mm reconstruction plate, fixed angle device.