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08 Jul 2025
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Diaphyseal Femur Fracture in Saul-Wilson Syndrome Managed with Double Plating

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Clinical Details

Clinical and radiological findings:  A 34-year-old female with Saul-Wilson syndrome presented with a diaphyseal femur fracture following a fall. The patient, who is 3.5 feet tall and weighs 90 pounds, was fully ambulatory within the community without assistive devices prior to the injury. Radiological evaluation revealed a simple diaphyseal fracture with a narrow medullary canal measuring approximately 2.5-3mm at the isthmus, and obliteration distal to the fracture site.

Preoperative Plan

Planning remarks:  The preoperative plan involved a double plating technique due to the narrow and obliterated medullary canal, which precluded the use of intramedullary nailing. An anterior approach was planned for the application of a 2.7mm strength plate, and a lateral approach for the application of an upside-down 3.5mm tibial plateau plate.

Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table was utilized to facilitate anterior and lateral access to the femur.

Anatomical surgical approach:  A longitudinal incision was made along the anterior aspect of the femur for the placement of the 2.7mm strength plate. A separate lateral incision was made for the application of the upside-down 3.5mm tibial plateau plate. Subperiosteal dissection was performed to expose the diaphysis, allowing for accurate plate placement and fixation.

Operative remarks: 

The use of double plating was chosen due to the mechanical soundness and ability to protect against future fractures without compromising the thin cortex by reaming. The upside-down tibial plateau plate provided adequate support and has been effective in similar cases involving skeletal dysplasia.

Postoperative protocol:   The postoperative rehabilitation protocol included protected weight-bearing as tolerated with gradual progression to full weight-bearing over several weeks, focusing on maintaining range of motion and strength.

Follow up:   Not specified

Orthopaedic implants used:   2.7mm strength plate, 3.5mm upside-down tibial plateau plate

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