Surgical Discussion

Patient positioning:  The patient was positioned supine on a fracture table to facilitate intramedullary nailing of the proximal femur.

Anatomical surgical approach:  A lateral approach to the proximal femur was utilized. The incision was made along the lateral aspect of the thigh, extending proximally to expose the entry point for intramedullary nailing. Careful dissection was performed to avoid damage to surrounding soft tissues.

Intraoperative frozen section analysis confirmed no evidence of malignancy, allowing for continuation with surgical fixation. Prior to sending the specimen, the pathologist was informed:

> "I'm 98% certain this is a unicameral bone cyst, but I need you to rule out malignancy. Please confirm whether there is any nuclear atypia or overt malignancy. Also, ensure the specimen is adequate for final histological diagnosis. My differential includes telangiectatic osteosarcoma."

Due to significant thinning of the lateral wall and a fracture line extending proximal to where a sliding hip screw side plate would end, intramedullary nailing was chosen over a locking plate. Grafting was not performed in this case.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing on the affected limb for 6 weeks, followed by gradual progression to full weight bearing as tolerated. Physical therapy focused on range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail.