PMC10152952_01
Views of right femur showing healed meta-diaphyseal femur fracture with previously placed intramedullary nail.
JOCR-13-70-g001.jpg
PMC10152952_01_JOCR-13-70-g001.jpg
F1
The patient had a solid antegrade femoral nail placed 22 years ago and had a well healed femoral shaft fracture with good cortical bone (Fig. 1).
(a) AP view of femoral Sawbones model (Vashon, WA) with horizontal lines denoting location of cerclage wires. (b) Lateral view depicting episiotomy performed along lateral edge of the femur just anterior to linea aspera. (c) Simulated intraoperative view of lateral femur with planned episiotomy.
JOCR-13-70-g002.jpg
PMC10152952_01_JOCR-13-70-g002.jpg
F2
To do so, the remainder of the femur was exposed distally using an extensile lateral subvastus approach (Fig. 2c). Next, a microsagittal saw was used to make a single linear longitudinal osteotomy down the femur just anterior to the linea aspera (Fig. 2a and b).
Right diaphyseal fitting total hip replacement with cerclage wires maintaining reduction after episiotomy.
JOCR-13-70-g003.jpg
PMC10152952_01_JOCR-13-70-g003.jpg
F3
Repeat radiographs demonstrated episiotomy healing and a well-fixed total hip arthroplasty at 3 months (Fig. 3).