Surgical Discussion

Patient positioning:  The patient was positioned supine for the procedure, allowing access to both the proximal and distal femur as well as the knee joint.

Anatomical surgical approach:  A medial subvastus approach was utilized for the distal femoral fracture. This involved splitting the vastus medialis muscle to access the fracture site. A terminally threaded Schanz pin was placed in the condyle for control, followed by interfragmentary lag screw placement. Percutaneous techniques were employed for reduction of the pertrochanteric fracture, with subsequent reaming and nailing.

The surgeon noted that maintaining reduction during nailing was critical, achieved through strategic placement of wires and clamps. After addressing the femoral fractures, attention was turned to the knee joint. The medial meniscus had an anterior root avulsion with the anterior half flipped under the rim fragment. Reduction of the meniscus and plateau fragment was performed through a small split in the anterior medial collateral ligament, supported with calcium phosphate (CaPO4) and buttressed. Despite some residual varus instability, it was anticipated that bracing would facilitate healing of the knee injuries.

Postoperative protocol:   Postoperative rehabilitation included bracing to address residual varus instability of the knee. Specific weight-bearing instructions were not detailed.

Follow up:   Not specified.

Orthopaedic implants used:   Terminally threaded 2.5mm Schanz pin, interfragmentary lag screws, 2.4mm wires, intramedullary nail, buttress plate, calcium phosphate (CaPO4).