Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table. A radiolucent leg holder was utilized to facilitate access to the proximal tibia and allow for intraoperative imaging.

Anatomical surgical approach:  A longitudinal incision was made over the patellar tendon, extending proximally to allow access to the knee joint. The suprapatellar approach was utilized, involving an arthrotomy through the quadriceps tendon to gain entry into the knee joint and access the proximal tibia for nail insertion.

The surgeon noted that the pseudoarthrosis required meticulous resection to achieve viable bone ends. The existing hardware was removed, and a suprapatellar tibial nail was inserted to stabilize the fracture. Posterior bone substitute was applied to fill any voids, and a cement spacer was used to provide additional support and promote healing.

Postoperative protocol:   Postoperatively, the patient was advised to maintain non-weight bearing status for 6 weeks, followed by gradual progression to partial weight bearing as tolerated. Physical therapy focused on range of motion exercises for the knee and strengthening of the quadriceps and hamstring muscles.

Follow up:   Not specified.

Orthopaedic implants used:   Suprapatellar tibial nail, posterior bone substitute, cement spacer.