Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table to facilitate access to the anterolateral aspect of the tibia and fibula.

Anatomical surgical approach:  A mini open anterolateral approach to the distal tibia was performed. The incision was made along the anterolateral aspect of the tibia, avoiding the medial skin due to its compromised condition. Subcutaneous tissues were carefully dissected to expose the fracture site. A provisional plate was applied anterolaterally to act as a reduction aid before intramedullary nailing.

The surgeon emphasized the importance of understanding the fracture pattern and implant characteristics when deciding between plating and nailing. An anterolateral plate was chosen for provisional fixation to resist valgus failure, as medial plating would not provide adequate support and could compromise the already vulnerable medial skin. The fibula, exhibiting a segmental and length-stable pattern, was stabilized with a retrograde intramedullary implant. The provisional plate's distal screws were removed post-nailing to allow it to function as a reduction aid rather than a definitive fixation.

Postoperative protocol:   Postoperatively, the patient was advised to follow a weight-bearing as tolerated protocol with gradual progression based on clinical and radiological healing. Early range of motion exercises were encouraged to prevent stiffness.

Follow up:   Not specified

Orthopaedic implants used:   Intramedullary nail for tibia, provisional anterolateral plate, interfragmentary compression screws, retrograde intramedullary implant for fibula.