Surgical Discussion

Patient positioning:  The patient was positioned laterally on the operating table. The down leg was extended to prevent interference with imaging, while the operative leg was flexed to aid in neutralizing the deformity.

Anatomical surgical approach:  A lateral approach was utilized, with an incision made over the greater trochanter. Subperiosteal dissection was performed to expose the proximal femur. Reduction was achieved using clamps placed laterally to tension the fracture site, ensuring they did not obstruct the nail jig.

The surgeon noted that closed reduction attempts were insufficient due to the significant deforming forces. An open reduction was performed promptly, minimizing operative time and reducing the risk of malreduction. The importance of achieving proper alignment before nail insertion was emphasized to prevent varus malreduction and potential nonunion.

Postoperative protocol:   Postoperatively, the patient was allowed partial weight-bearing with crutches for six weeks, progressing to full weight-bearing as tolerated by eight weeks. Physical therapy focused on range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Trochanteric entry intramedullary nail, reduction clamps.