Surgical Discussion

Patient positioning:  The patient was positioned supine on a fracture table, allowing for traction and manipulation of the affected limb to achieve optimal reduction of the fracture.

Anatomical surgical approach:  A lateral approach to the proximal femur was utilized. An incision was made along the lateral aspect of the thigh, followed by dissection through the fascia lata to expose the proximal femur. The vastus lateralis muscle was elevated anteriorly to access the lateral aspect of the femur for DHS placement.

During the insertion of the DHS side plate, an iatrogenic fracture of the greater trochanter occurred, avulsing a portion of the bone with attached abductor musculature. This complication necessitated additional fixation strategies to stabilize the avulsed fragment and ensure proper reattachment of the abductors. The surgical team employed additional fixation techniques, including cerclage wiring, to secure the greater trochanter and restore abductor function.

Postoperative protocol:   Postoperatively, the patient was advised partial weight-bearing with crutches for 6 weeks to allow for healing of both the femoral neck fracture and the iatrogenic greater trochanteric fracture. Progressive weight-bearing was planned based on radiographic evidence of healing.

Follow up:   Not specified.

Orthopaedic implants used:   Dynamic Hip Screw (DHS), Cerclage Wire.