Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to allow for intraoperative fluoroscopic guidance. A bolster was placed under the knee to maintain slight flexion, facilitating access to the distal femur entry point.

Anatomical surgical approach:  A midline incision was made over the patellar tendon, extending distally to the tibial tuberosity. The patellar tendon was retracted laterally to expose the intercondylar notch. A guide wire was inserted through the entry point in the distal femur, followed by reaming and insertion of the retrograde intramedullary nail. Blocking screws were placed strategically to correct and stabilize the fracture alignment.

The operative strategy emphasized achieving a high-quality reduction to enable immediate weight-bearing. The use of blocking screws provided additional stability and facilitated precise alignment of the fracture fragments. The discussion highlighted the variability in treatment approaches for distal femur fractures, with options including plating, nailing, or a combination of both. The chosen method aimed to balance stability with early mobilization.

Postoperative protocol:   The postoperative rehabilitation protocol allowed for immediate weight-bearing as tolerated by the patient. Emphasis was placed on early mobilization to enhance recovery and functional outcomes.

Follow up:   Not specified.

Orthopaedic implants used:   Retrograde intramedullary nail, blocking screws.