Introduction:
Rate of obese patients are on the rise and fractures on these patients are difficult to treat, risk of management failure is high as they are more prone to develop wound infection, hardware failure, malunion and prolonged procedure time.
Case report:
In this report, we present a case on how we successfully managed a supracondylar femur fracture in a patient with a body mass index of 98.1 kg/m2 with surgical site infection as the main complication. No literature reported such a case with an astonishing weight of 264 kg given the case uniqueness and importance.
Conclusion:
A retrograde intramedullary nailing of the femur was performed under difficult circumstances, with a variety of modification to be considered pre-peri and post-operatively. It is advised based on the literature review and expert opinion to take the recommendations into consideration for better outcome.