The patient was positioned supine on a radiolucent table. The entire leg and buttock were prepped and draped. The knee wound was lateral to the patella. It was extended distally into a lateral parapatellar incision. Debridement down to the knee joint was performed. The patellar tendon was intact. A small nondisplaced peripheral patellar fracture was noted. The wound was also extended proximally for complete debridement. The proximal wound was extended both proximally and distally to expose the area of periosteal stripping. Necrotic subcutaneous tissue and quadraceps muscle were debrided. No gross contamination was present in either wound.
Through the proximal extension of the distal wound, the distal femur could be approached. Two 6.5 mm partially-threaded cancellous screws were placed from the anterior aspect of the lateral femoral condyle to secure the nondisplaced intercondylar fracture. Through the distal wound, a retrograde intramedullary nail was inserted. The lag screws were anterior to the path of the nail. The distal femur fracture reduced easily, the proximal fracture needed longitudinal traction and manipulation of the fragments with reduction forceps. The distal interlocking screws through the nail provided adequate distal fixation (Figure 4, Figure 5, Figure 6, Figure 7). Two proximal interlocking screws were placed. Deep suction drains were placed in the depths of the wounds. The wounds were closed primarily.