Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a radiolucent table to facilitate intraoperative imaging and access to the anterolateral aspect of the lower leg.

Anatomical surgical approach:  A longitudinal anterolateral incision was made over the distal tibia. Subperiosteal dissection was performed to expose the fracture site. The fibula was addressed first to correct its plastic deformation, which subsequently aided in realigning the tibial fracture. An anterolateral plate was applied to stabilize the tibia after achieving satisfactory reduction.

The surgeon noted that addressing the fibular plastic deformation was crucial in achieving proper alignment of the tibial fracture. The initial plan to avoid fibular intervention was reconsidered due to its significant impact on tibial alignment. The case highlighted the importance of understanding pediatric bone mechanics, particularly the role of plastic deformation and its influence on fracture management.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a cast with non-weight bearing for 6 weeks, followed by gradual weight-bearing as tolerated. Physical therapy was initiated to restore range of motion and strength.

Follow up:   Not specified.

Orthopaedic implants used:   Anterolateral tibial plate, screws for fixation.