Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table with a bump under the ipsilateral hip to allow for slight external rotation of the limb, facilitating access to both the anterolateral and posteromedial aspects of the proximal tibia.

Anatomical surgical approach:  A longitudinal anterolateral incision was made, extending from Gerdy's tubercle distally along the tibial shaft. The iliotibial band was split in line with its fibers, and a submeniscal arthrotomy was performed to expose the lateral tibial plateau. A separate posteromedial incision was made to address any posterior fragments if necessary.

The articular fragments were reduced using pointed reduction forceps and temporarily stabilized with K-wires. Interfragmentary compression was achieved using lag screws for absolute stability. A long 4.5mm locking compression plate was applied submuscularly along the lateral aspect of the tibia, bridging the metaphyseal comminution and providing relative stability. Care was taken to preserve soft tissue attachments and maintain fracture hematoma.

Postoperative protocol:   Postoperatively, the patient was placed in a hinged knee brace allowing for immediate passive range of motion exercises. Weight-bearing was restricted to toe-touch for 6 weeks, progressing to partial weight-bearing at 8 weeks, and full weight-bearing as tolerated by 12 weeks.

Follow up:   Not specified

Orthopaedic implants used:   4.5mm Synthes LCP locking plate, K-wires, lag screws