Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table.

Anatomical surgical approach:  A classical ilioinguinal approach was utilized. The incision was made parallel to the inguinal ligament, extending from just lateral to the anterior superior iliac spine (ASIS) towards the pubic tubercle. Dissection proceeded through the subcutaneous tissue and external oblique aponeurosis, with careful identification and protection of the neurovascular structures within the three windows of the ilioinguinal approach. The anterior column fragments were exposed and reduced using clamps. The quadrilateral surface and posterior column were buttressed with a contoured reconstruction plate. The medial dome impaction zone was identified under fluoroscopic guidance, reduced to the femoral head, and supported with allograft bone. The anterior column reduction was stabilized with a contoured reconstruction plate, and additional lag screws were placed as needed to secure the posterior column.

Manual traction intraoperatively demonstrated the appropriate position of the femoral head. Reduction of the quadrilateral surface and posterior column was achieved prior to addressing the impaction zone. The impacted dome fragment was anatomically reduced and supported with allograft bone grafting. An offset clamp was utilized to improve posterior column reduction when necessary before definitive fixation with lag screws. Intraoperative fluoroscopy confirmed satisfactory reduction and implant placement.

Postoperative protocol:   Postoperatively, weight bearing was protected for 4-6 weeks using crutches or a walker as tolerated, though most patients weight bear as tolerated for various reasons.

Follow up:   Not specified

Orthopaedic implants used:   Contoured reconstruction plates, lag screws, allograft bone