Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table to facilitate access to the proximal femur and allow for intraoperative imaging.

Anatomical surgical approach:  A lateral approach to the proximal femur was utilized, involving careful dissection to expose the fracture site. The wound was thoroughly debrided, and irrigation was performed to address contamination. Trochanteric fragments were stabilized using #5 sutures anchored into the gluteus medius tendon.

The surgical team opted for a single-stage procedure due to the nature of the Gustilo-Anderson Type 3A open fracture, which was closeable despite moderate contamination. The critical bone defect was addressed using the Masquélet technique, with an antibiotic-loaded PMMA spacer containing vancomycin and tobramycin. This approach is supported by literature for managing critical-sized bone defects and allows for potential deferral of bone grafting if early callus formation is observed.

Postoperative protocol:   Postoperatively, the patient followed a rehabilitation protocol emphasizing early mobilization within pain tolerance and weight-bearing as tolerated, with close monitoring for signs of infection or complications.

Follow up:   Not specified

Orthopaedic implants used:   Reconstruction intramedullary nail, #5 sutures, Antibiotic-loaded PMMA cement spacer (vancomycin and tobramycin).