Surgical Discussion

Patient positioning:  The patient was positioned supine on a fracture table to allow for optimal access and manipulation of the proximal femur.

Anatomical surgical approach:  A lateral approach to the proximal femur was utilized. This involved a longitudinal incision over the lateral aspect of the hip, followed by subperiosteal dissection to expose the greater and lesser trochanters. Osteotomies were performed on both trochanters to correct the malunions.

The lesser trochanter malunion posed significant challenges in achieving sagittal plane correction, necessitating an osteotomy for successful realignment. The greater trochanter malunion was corrected with a straightforward osteotomy. A 4.5 narrow combi plate was employed for compression and stabilization, while a trapezoidal-shaped intramedullary nail was selected for its proximal press-fit capability and dual screw design, providing robust proximal fixation. Biological augmentation was achieved using a combination of cytokines, bone morphogenetic proteins (BMPs), and allograft.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with gradual progression as tolerated, focusing on maintaining range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   4.5 narrow combi plate, trapezoidal intramedullary nail, dual proximal screws, allograft, cytokines, BMPs.