Surgical Discussion

Patient positioning:  The patient is positioned supine on a radiolucent table to facilitate intraoperative imaging and access to the lateral aspect of the femur.

Anatomical surgical approach:  A lateral approach to the femur is utilized, involving an incision over the lateral aspect of the thigh. Dissection proceeds through the fascia lata, with careful subperiosteal elevation of the vastus lateralis muscle to expose the femoral shaft. Care is taken to preserve soft tissue attachments and fracture hematoma.

The surgeon notes that achieving high-quality reduction in terms of length, coronal and sagittal plane alignment, and rotation is critical. The use of a bridge plate with low screw density allows for controlled interfragmentary motion, promoting secondary bone healing. The technique avoids the use of lag screws due to osteopenic bone quality, which would not provide sufficient grip for absolute stability.

Postoperative protocol:   Postoperative rehabilitation includes early weight bearing as tolerated, with progression based on clinical and radiographic evidence of healing. Physical therapy focuses on range of motion and strengthening exercises to promote functional recovery.

Follow up:   Not specified

Orthopaedic implants used:   Stout bridge plate with low screw density