Surgical Discussion

Patient positioning:  The patient was positioned supine on a traction table, although traction was not effective in improving fracture alignment preoperatively.

Anatomical surgical approach:  The surgical approach commenced with the Heuter approach, involving an incision over the anterior aspect of the hip joint. Due to significant deformity and muscular build, a rectus femoris tenotomy was performed to facilitate exposure of the cranially displaced fracture. Following reduction, a subvastus approach was utilized for lateral access to the femur, allowing for precise placement of fixation devices.

The surgeon noted that the degree of displacement made the Heuter approach less straightforward, necessitating a rectus tenotomy for adequate exposure. Preloading 2.0 and 2.4mm wires facilitated immediate fixation post-reduction, minimizing the risk of losing reduction during lateral approach preparation. The decision to fix rather than replace was based on preserving native joint function in this young patient, despite the elevated AVN risk.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing (NWB) status initially, progressing to partial weight bearing (PWB) as tolerated over 6-8 weeks, with gradual increase to full weight bearing (FWB) by 12 weeks post-surgery. Range of motion exercises were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   2.0mm and 2.4mm Kirschner wires for provisional fixation; definitive fixation details not specified.