Guidelines are not revelations
Right so this is fall from height of a 52 years old who is a tree surgeon The images are from A&E and then image intensifier when in theaters . Looks stable enough
What would you have done ?
Conservative
DHS
Nail
Complex THR
Blade plate
Pray
To my eyes 2 points after reduction the lateral cortex is broken exactly at the point where the lag screw is going to go through. Secondly after reduction it looks more like asubtrochanteric rather than intertrochanteric fracture
But being somewhere , where NICE guidelines are taken as a revelation this is what we did
Can be criticised obviously about fixation but decent enough!!
But this is what we got eventually very soon after surgery. No surprise
What do we do now
Pray
Nail
ReDHS
THR
Blade plate
So we did what used to be treatment for non unions of proximal femur.Again seems like a decent job by a decent surgeon
But then this happens. Murphy’s Law
How doe salvage this now.
Options
Pray
Pray
Pray
Redo
So we did this eventually which went on to heal.
Moral of the story
DONOT DO A DHS WHEN YOU NEED TO DO A NAIL
GUIDELINES ARE NOT REVELATIONS
