Surgical Discussion

Patient positioning:  Supine positioning was utilized to facilitate access via the anterior approach, allowing for optimal exposure of the femoral head.

Anatomical surgical approach:  An anterior Heuter approach was employed, involving an incision along the interval between the sartorius and tensor fascia latae muscles. Subperiosteal dissection was carried out to expose the hip joint capsule, followed by capsulotomy to access the femoral head for fracture fixation.

The femoral head was fixed anteriorly, and a stress examination was conducted to assess stability. Despite initial confidence in stability post-fixation, the patient exhibited near dislocation during stress testing, indicating residual instability. Retrospective consideration suggested that a Gibson approach with a trigastric slide might have been more appropriate to address both the head and posterior wall/capsulolabral complex. However, this experience reinforced the current protocol of fixing from the front and addressing posterior instability only if necessary.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with crutches for six weeks, followed by gradual progression to full weight-bearing as tolerated. Range of motion exercises were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included screws for fixation of the femoral head fracture.