Surgical Discussion

Patient positioning:  The patient was positioned laterally on a flattop operating table to facilitate access to the proximal femur and allow for accurate reduction and fixation.

Anatomical surgical approach:  A lateral approach to the femur was employed, involving a small incision over the greater trochanter. The vastus lateralis muscle was retracted anteriorly to expose the proximal femur. Percutaneous techniques were initially attempted for fracture reduction, with open reduction performed as needed.

During the procedure, an initial attempt at nail insertion resulted in a varus deformity due to a too lateral start site. To address this, the intramedullary nail was removed, and a blocking bit was placed to guide proper alignment. This adjustment allowed for maintenance of a high-quality reduction during subsequent nail placement and screw fixation.

Postoperative protocol:   Postoperatively, the patient was advised to adhere to partial weight-bearing on the affected limb for six weeks, followed by progressive weight-bearing as tolerated. Physical therapy focused on range of motion exercises and strengthening of the surrounding musculature.

Follow up:   Not specified.

Orthopaedic implants used:   Reconstruction type intramedullary nail, blocking bit.