The patient will be brought urgently to the operating room where both wounds, the femur fracture, and the knee joint will be debrided. If no gross contamination is found, and the patient condition is favorable, definitive fixation can be performed.
The pre-operative plan revealed an 18 hole DCS or blade plate would be required. A long lateral incision with more soft tissue disruption would be required for placement of the implant. Subcutaneous insertion techniques might allow placement of the DCS but reduction of both shaft fractures may be difficult. The locking condylar plate and the LISS plate would also be very long implants. All these plates are at a biomechanical dis-advantage because they are at a distance from the neutral axis of bending. An antegrade femoral nail would not allow adequate distal fixation.
The distal intracondylar component of the fracture could be stabilized with screws. A retrograde femoral nail would provide stability for both shaft fractures. Insertion would be done through the same incision that was used to irrigate and debride the knee joint.