Surgical Discussion

Patient positioning:  The patient was positioned laterally on the operating table to facilitate access to the lateral aspect of the femur for plating.

Anatomical surgical approach:  A lateral approach to the femur was utilized. An incision was made along the lateral aspect of the thigh, extending from the greater trochanter distally. Subcutaneous tissues were dissected, and the fascia lata was incised to expose the lateral surface of the femur. Careful dissection around the existing nail was performed to allow for placement of the lateral plate.

The surgeon noted that proximal fixation was challenging due to the presence of the stemmed femoral component and existing nail. The decision to link the plate and nail with a 5mm locking screw was critical in achieving stable fixation. This approach allowed for effective load sharing between the plate and nail, addressing the mechanical insufficiency of the initial construct.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with crutches for six 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:   Long intramedullary nail, lateral femoral locking plate, 5mm locking screw.