Vitamin D and Metabolic Supplementation in Orthopedic Trauma.

A 24-year-old obese male sustains an accidental close-range shotgun injury to his left thigh and is brought to the emergency department as a level 1 trauma with an open subtrochanteric femur fracture (Figure A). CT angiography reveals no superficial femoral arterial injury, and he undergoes irrigation of a six-centimeter open wound followed by closed reduction and intramedullary nailing. He does well initially, however, he endorses increasing thigh pain at nine months after surgery. There is some erythema around his prior open wound, but no wound dehiscence; updated imaging is shown in Figure B. Which of the following is the most appropriate next step in management?