Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table to facilitate fluoroscopic imaging. The affected limb was prepared for access to both the femur and tibia.

Anatomical surgical approach:  For the tibia, a longitudinal incision was made to access the proximal tibial start site for intramedullary nailing. Percutaneous clamps were utilized for reduction, supplemented by blocking screws as needed. For the distal femur, an external fixator was applied initially, followed by an in situ lateral approach for plating after reduction was achieved.

The tibial nailing required precise identification of the start site under fluoroscopic guidance, with percutaneous clamps aiding in reduction. Blocking screws were considered but not necessary due to successful reduction with clamps alone. The distal femur presented challenges in achieving coronal and sagittal alignment, necessitating reliance on the external fixator for reduction before proceeding with plating.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with weight-bearing as tolerated on the tibia, while the femur required protection until definitive fixation was achieved. Progressive weight-bearing was introduced following femoral plating.

Follow up:   Not specified

Orthopaedic implants used:   Intramedullary nail for tibia, external fixator for initial femoral stabilization, and locking plate for definitive femoral fixation.