Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the knee in semi-extension to facilitate a lateral extra-articular parapatellar approach for intramedullary nailing.

Anatomical surgical approach:  A lateral extra-articular parapatellar approach was utilized, avoiding instrumentation through the patellofemoral joint. This approach provided access for intramedullary nailing of the tibia while allowing separate fixation of the plafond with screws.

The surgeon emphasized the importance of treating the tibia and ankle as separate entities despite their mechanical interrelation. The decision to use intramedullary nailing was based on its mechanical advantages and familiarity, although plating was acknowledged as a viable alternative. The surgeon preferred the lateral extra-articular parapatellar approach over retropatellar due to its reduced impact on the knee joint and ease of use during nailing.

Postoperative protocol:   Postoperatively, the patient was instructed to maintain touch weight-bearing for 4 weeks, progressing to partial weight-bearing by week 5, and full weight-bearing by week 6. Range of motion exercises for the ankle were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, screws for plafond fixation.