Surgical Discussion

Patient positioning:  The patient was positioned supine on a flat-top operating table without changes in positioning for all three surgical interventions.

Anatomical surgical approach:  The anatomical approach for the pelvic fixation involved a standard anterior approach to the pelvis for external fixation placement. For the femur, a lateral approach to the proximal femur was utilized, involving an incision over the greater trochanter extending distally along the femoral shaft. The forearm fractures were approached via volar Henry and dorsal approaches to the radius and ulna respectively.

The surgeon noted that despite the seemingly simple pattern of the pertrochanteric femur fracture, reduction was challenging and required open clamping techniques to achieve satisfactory alignment. This complexity is typical in such fractures due to muscular forces and fracture morphology.

Postoperative protocol:   Postoperative rehabilitation included weight bearing as tolerated on the left leg, toe-touch weight bearing on the right side for 10 weeks, and platform weight bearing through the elbow on the affected forearm.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator for pelvis stabilization, intramedullary nail or plate for femur fixation, and plates and screws for forearm fracture fixation.