Surgical Discussion

Patient positioning:  The patient was positioned supine on a fracture table with the affected limb in slight internal rotation to facilitate reduction. A radiolucent table was used to allow for intraoperative fluoroscopy.

Anatomical surgical approach:  A longitudinal incision was made along the lateral aspect of the hip, centered over the greater trochanter. The fascia lata was incised in line with the skin incision, and the vastus lateralis muscle was split longitudinally to expose the lateral aspect of the proximal femur. Subperiosteal dissection was performed to visualize the fracture site. Reduction was achieved using traction and manipulation under fluoroscopic guidance.

Intraoperatively, the fracture reduction was challenging due to comminution at the fracture site. Temporary fixation was achieved with Kirschner wires, followed by placement of a guide wire for the DHS. The lag screw was inserted into the femoral head, ensuring optimal positioning within the subchondral bone. The side plate was then attached to the femoral shaft, and additional screws were placed to secure the construct. Intraoperative fluoroscopy confirmed satisfactory reduction and fixation.

Postoperative protocol:   Postoperatively, the patient was allowed toe-touch weight-bearing with a walker for six weeks to protect the repair. Physical therapy focused on range of motion exercises and gradual strengthening of the hip abductors. Full weight-bearing was anticipated by three months post-surgery, contingent on radiographic evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   Dynamic Hip Screw (DHS) system with a 135-degree side plate and 4-hole configuration.