Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table. A radiolucent table was used to facilitate intraoperative imaging. The knee was maintained in a semi-extended position to allow for optimal access and alignment during nailing.

Anatomical surgical approach:  A longitudinal infrapatellar incision was made, followed by careful dissection to expose the proximal tibia. The entry point for the intramedullary nail was established at the anterior aspect of the tibial plateau, just medial to the lateral tibial spine. A blocking wire was placed to guide the reamers and maintain alignment.

Intraoperative challenges included maintaining guidewire alignment due to the comminuted nature of the fracture. The use of a blocking wire proved essential in preventing medial deviation during reaming, ensuring proper alignment of the intramedullary nail. The semi-extended position facilitated easier access and visualization of the entry point.

Postoperative protocol:   Postoperatively, the patient was advised to begin partial weight-bearing as tolerated with crutches, progressing to full weight-bearing over 6-8 weeks based on clinical and radiographic assessment. Range of motion exercises for the knee were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, blocking wire, guidewire, reamers.