Surgical Discussion

Patient positioning:  The patient was positioned supine on a flattop table, allowing for optimal manipulation and imaging access during the percutaneous reduction procedure.

Anatomical surgical approach:  A percutaneous approach was utilized, involving small incisions for the insertion of instruments to achieve reduction and fixation. The anti-rotation screw and wires were placed percutaneously to stabilize the fracture fragments, followed by the application of a sliding hip screw side plate.

The surgeon opted for a percutaneous reduction due to the circumferential comminution of the femoral neck, which made an open reduction less beneficial. The use of a fixed angle implant (sliding hip screw and side plate) was chosen based on emerging evidence suggesting its superiority over non-fixed angle constructs for this fracture type. The procedure was performed on a flattop table, which is the surgeon's preference for such cases.

Postoperative protocol:   Postoperatively, the patient was instructed to engage in flat foot weight bearing of the leg only for three months to allow for adequate healing of the fracture.

Follow up:   Not specified.

Orthopaedic implants used:   Anti-rotation screw, multiple wires, sliding hip screw side plate (fixed angle).