Surgical Discussion

Patient positioning:  The patient was positioned supine for the femoral procedure and likely maintained in a similar position for subsequent tibial interventions to facilitate access to both the proximal femur and tibia.

Anatomical surgical approach:  A longitudinal incision was made for the femoral approach to accommodate the insertion of an anterograde intramedullary nail. For the tibial plateau, a percutaneous approach was utilized for fixation, with additional soft tissue management through flap closure techniques.

The surgeon noted the complexity of managing the malunion and soft tissue injury. The use of bioactive crystal bone substitute was emphasized for both femoral and tibial reconstructions. The application of a circular external fixator provided necessary stability and facilitated soft tissue healing through arthrodiastasis.

Postoperative protocol:   Postoperative rehabilitation included walking training and muscle strengthening exercises. The use of an external fixator allowed for early mobilization while protecting the surgical site.

Follow up:   Not specified.

Orthopaedic implants used:   Anterograde intramedullary nail, bioactive crystal bone substitute, circular external fixator.