Surgical Discussion

Patient positioning:  The patient was positioned laterally on a flat-top operating table with the affected leg free to allow for optimal access and manipulation during the surgical procedure.

Anatomical surgical approach:  A lateral subvastus approach was performed, involving an incision along the lateral aspect of the thigh, with careful dissection through the vastus lateralis muscle to expose the subtrochanteric region. Concurrently, a Watson-Jones approach was utilized for the femoral neck, involving an incision over the anterior aspect of the hip, retracting the tensor fascia lata and gluteus medius to access the femoral neck.

The surgeon noted that closed reduction was not feasible due to the fracture complexity)Scroll through the fluoro images — these are manual traction views, closely simulating what you'd expect to see if the patient were placed on a fracture table.)

. A collinear clamp was employed to achieve reduction of the neck and trochanteric fragments, ensuring proper alignment. Cerclage wiring was applied to stabilize the subtrochanteric fracture. The nail entry point was deliberately medialized to prevent varus malalignment. The integrated screw design of the chosen implant allowed for significant compression across the basi-cervical fracture, achieving stable fixation.

Postoperative protocol:   Postoperatively, the patient was advised to adhere to a non-weight-bearing protocol on the affected limb for 6 weeks, followed by progressive weight-bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail with integrated screw design, collinear clamp, cerclage wires.