Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, allowing for sequential access to the posterolateral, posteromedial, and anterolateral surgical fields.

Anatomical surgical approach:  The surgical approach began with a posterolateral incision to expose and fix the fibula. A posteromedial incision was then made to access and remove the interposed corticocancellous fragment, followed by reduction of the Volkmann fragment and the anteromedial fragment. Finally, an anterolateral incision was utilized to address the large anterolateral joint fragment. Each approach was executed with precision to allow for interfragmentary compression and primary bone healing.

The surgeon noted that the interposition of the large corticocancellous fragment necessitated its removal for successful joint reduction. The use of multiple approaches allowed for direct visualization and manipulation of each fracture component, facilitating anatomical reduction and stable fixation. The syndesmosis was found to be stable following fixation of the Volkmann and anterolateral fragments.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with protected weight-bearing as tolerated, progressing to full weight-bearing as healing permitted. Range of motion exercises were initiated early to prevent stiffness.

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used included mini fragments plate + interfragmentary screws for compression and stabilization across the fracture sites.