Operative Steps for Removal of Proximal Femoral Nail (PFN)-A2

Pre-operative Preparation

Adequate anesthesia should be administered and patient positioned supine on a fracture table with the affected limb draped free after standard aseptic preparation, as recommended by the American Society of Anesthesiologists 1
Ensure appropriate imaging equipment is available and properly positioned for intraoperative guidance, following guidelines from the Infectious Diseases Society of America 2

Dissect carefully through subcutaneous tissue down to the fascia lata, and incise the fascia lata in line with the skin incision and split the gluteus medius in line with its fibers, as suggested by the Clinical Microbiology and Infection society 2
Irrigate all wounds copiously with saline solution, achieve meticulous hemostasis, close in layers, and apply sterile dressing, following guidelines from the Clinical Microbiology and Infection society 2

Patients should be monitored for pain, neurovascular status, and early mobilization, and prophylactic antibiotics should be administered according to hospital protocol, as recommended by the American Society of Anesthesiologists 1
Thromboprophylaxis should be continued as appropriate, following guidelines from the American Society of Anesthesiologists 1