Surgical Discussion

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

Anatomical surgical approach:  A lateral approach to the femur was performed, involving an incision along the lateral aspect of the thigh. Subperiosteal dissection was carried out to expose the fracture site while preserving as much periosteum as possible. Care was taken not to disturb the medullary hematoma, and reamings were collected for later use in grafting.

The surgeon noted that indirect reduction techniques were inadequate due to the fracture's complexity, necessitating an open reduction. Emphasis was placed on preserving fracture biology by minimizing periosteal stripping and avoiding suctioning of the medullary hematoma. Reamings were used as autograft material around the fracture site to enhance healing.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with toe-touch weight-bearing (TTWB) for 6 weeks, followed by progressive weight-bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, autologous bone graft from reamings.