Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, allowing for ease of access to the tibial plateau and facilitating fluoroscopic guidance during percutaneous reduction.

Anatomical surgical approach:  A percutaneous approach was utilized for reduction of the tibial plateau fracture. Small incisions were made to allow for the insertion of reduction instruments and guide wires under fluoroscopic control. The Ilizarov external fixator was applied circumferentially around the limb, with transosseous wires and half-pins placed strategically to maintain reduction and provide stability.

The surgeon noted that percutaneous reduction was achieved satisfactorily, with adequate alignment of the articular surface. The Ilizarov frame provided excellent stability while allowing for joint distraction, which was deemed beneficial for soft tissue recovery and potential cartilage regeneration. The decision to employ arthrodiastasis was based on the need to protect the joint surface while maintaining mobility.

Postoperative protocol:   Postoperative rehabilitation included immediate initiation of range of motion exercises within the limits allowed by the Ilizarov frame. Weight-bearing was restricted initially, with gradual progression based on clinical and radiological assessment of fracture healing and soft tissue condition.

Follow up:   Not specified.

Orthopaedic implants used:   Ilizarov external fixator system.