Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected limb elevated to optimize exposure and facilitate surgical access.

Anatomical surgical approach:  A modified extensile anterolateral approach was employed. The incision extended along the anterolateral aspect of the distal tibia. The anterior compartment was retracted laterally to expose the fracture site. An arthrotomy was performed at the medial border of the Chaput fragment to access the joint. The Chaput fragment was rotated out, allowing reduction of the medial fragment to the Volkmann fragment, followed by reduction of the Chaput fragment itself. Proximally, the anterior compartment was retracted laterally to access and anatomically reduce the metaphyseal fragments.

The surgeon noted that the single stage approach was feasible due to the low energy mechanism and minimal soft tissue involvement. The modified extensile anterolateral approach provided adequate exposure for reduction and fixation of the fracture fragments. Careful handling of soft tissues was emphasized to prevent complications.

Postoperative protocol:   Postoperatively, the patient was advised to maintain non-weight bearing status for six weeks, followed by gradual weight-bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included a distal tibial locking plate and screws for fixation of the pilon fracture.