51 y.o. Male s/p Pretrochanteric Fracture Treated Non-Operatively

By Antoine Maalouf

51 y.o healthy male who sustained a left pertronchanteric fracture 3 months ago following a MVA in a remote region where he did not have access to proper orthopedic treatment. He was treated with bed rest and non weight bearing followed by progressive return to weight bearing.

He is currently complaining of severe mechanical pain, limping, and a LLD of 8 cm. His hip musculature is preserved albeit restricted by pain and stiffness (abduction 30deg, flexion 90deg, rotations 15 deg). Pain killers are getting inefficient in controlling his pain and his daily activities are much hindered.

Xrays and CT scan confirm a severe malunion of the proximal femur.

What is the best surgical option? Which approach? Do you use an ortho table, a transosseous traction or nothing at all?

Thank you for your advice!

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