The piriformis fossa was clearly disrupted by the fracture and plate fixation was felt to to have the most predictable outcome. OIRF with a 95-degree fixed angle device was chosen because of the severity of comminution and the degree of instability.
Biologic fixation techniques with indirect reduction to restore the femoral length and alignment of the shaft along with a normal neck-shaft angle and anteversion of the femoral head were chosen.
Pre-operative planning was done. A 14- or 16- hole side plate would be required to achieve adequate fixation to the shaft. At the time, a check of our hospital inventory showed that there was not a long enough blade plate in stock, so a dynamic condylar screw was used. The proposed insertion site of the lag screw was traced on the preoperative plan (Figure 2).