Operative Treatment

The patient was positioned under general anesthesia on a fracture table. Traction was applied to the femur by a distal femoral pin that had been previously placed. Fluoroscopic images of the femur taken after positioning of the patient showed that length and alignment were restored, with some residual displacement of the intermediate fragments.

A lateral approach to the proximal femur was begun. The iliotibial band was divided, and the vastus lateralis muscle was elevated bluntly from the posterior intermuscular septum. Initially, only the trochanteric area was exposed. The intermediate fragments were left in place, and care was taken to minimize any soft tissue stripping from them.

A guide pin was drilled into the femoral neck and head at the site determined preoperatively, and its position confirmed fluoroscopically. The triple-combination reamed was used to drill the hole for the lag screw, which was then inserted.

The femoral shaft was palpated distally, beneath the vastus lateralis. A 14- and 16-hole side plate were placed against the femur, and it was determined that the 14-hole length was adequate. The selected plate was passed beneath the vastus lateralis and onto the distal fragment. The intact femoral shaft distal to the fracture was exposed by further elevation of the vastus lateralis. The comminuted segment of the femur in the subtrochanteric region was never exposed. After the DCS barrel was inserted over the femoral neck lag screw, the side plate was fixed to the femur with five bicortical screws. The wound was closed primarily over a drain. Postoperative radiographs were obtained Figure 3 and Figure 4

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