Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected leg slightly elevated using a supportive bolster to facilitate access to the lateral aspect of the thigh and knee.

Anatomical surgical approach:  A longitudinal incision was made along the anterolateral aspect of the thigh, extending from the vastus lateralis muscle distally towards the lateral epicondyle of the femur. Subfascial dissection was performed to expose the lateral aspect of the femur, taking care to protect the surrounding neurovascular structures. The fracture site was identified, and meticulous dissection was carried out to preserve the soft tissue envelope around the prosthesis.

To avoid "golf club malreduction," care was taken not to compress the femur laterally with a plate.

Postoperative protocol:   Postoperative rehabilitation protocol included immediate mobilization with non- weight-bearing Range of motion exercises were initiated early under physiotherapist supervision to prevent stiffness and promote joint function.

Follow up:   At 1 year follow-up, the patient demonstrated satisfactory progress with evidence of fracture healing on radiographs. She was ambulating independently with a walking aid.

Orthopaedic implants used:   Distal femoral locking plate system, cortical and locking screws.