PMC5974684_01
AP radiograph of the pelvis showing a subcapital type of femur neck fracture with a Dorr type C canal.
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F1
A radiograph of the pelvis showed a subcapital type of femur neck fracture with a Dorr type C canal (Fig. 1).
AP and lateral radiograph of the knee showing arthrodesed knee with osteomyelitis sequelae and destroyed distal femoral anatomy.
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F2
A radiograph of the knee showed arthrodesis of the knee (Fig. 2).
Axial computed tomography scan cuts of the affected limb taken at the level (a) superior pole of patella, (b) epicondyles, (c) roof of intercondylar notch, (d) proximal tibia.
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F3
The posterior condyles, medial and lateral epicondyles could not be appreciated on pre-operative computerised tomography (CT) scan (Fig. 3).
(a) Version of lesser trochanter with respect to the posterior condylar plane (normal limb) (51), (b) version of femur neck with respect to posterior condylar plane (normal limb) (4.28), (c) version offemur neck with respect to lesser trochanter (normal limb) (55.28 ).
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F4
On CT scan, the version of lesser trochanter with respect to the posterior bicondylar axis and the femur neck was measured on the unaffected side as per the technique described by Imai et al. and Unlu et al. (Fig. 4).
Normal limb in a neutral position with patella centered and facing up. Inset: AP view of the hip in the same position.
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F5
A C-arm shoot of the pelvis was taken to identify the lesser trochanter profile (Fig. 5).
Normal limb rotated, under flouroscopic guidance, till the lesser trochanter disappears. Angle is measured with respect to the vertical plane. Inset: AP view of the hip with lesser trochanter disappeared.
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F6
Under fluoroscopic guidance, the limb was then internally rotated till the lesser trochanter disappears (Fig. 6).
The affected limb is rotated, under fluoroscopic guidance, till the lesser trochanter disappears. A K-wire is drilled into the distal femur at 76 from the horizontal in this position. Black arrow points the direction of the patella (if it would have been present). Purple line represents the horizontal. Inset: AP view of the hip with lesser trochanter disappeared.
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F7
Hence, a wire (2 mm K-wire) is inserted percutaneously, in the distal femur, from the lateral side at 76  from the horizontal (90 -14 = 76 ) (Fig. 7).
The affected limb is rotated till the K- wire is vertical. A AP view of pelvis showing lesser trochanter profile similar to that of the normal limb in a neutral position. Inset: AP view ofthe hip in the same position.
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F8
This can be confirmed by checking the profile of lesser trochanter and comparing it with the normal side (Fig. 8).
Intraoperative photo showing the broach inserted at an angle of 15 of anteversion with respect to the plane of the K-wire. Small red arrow points to the K-wire which is placed parallel to the ground. The thick red and purple lines represent the axis of the K-wire and the broach, respectively.
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F9
A large Muller collarless stem was then cemented into place maintaining 15  of anteversion (Fig. 9).