Surgical Discussion

Patient positioning:  Prone positioning was utilized for the posterolateral and posteromedial approaches, allowing optimal access to the posterior and medial fracture components.

Anatomical surgical approach:  The initial surgical approach involved using the traumatic medial wound for debridement and external fixation. The posterolateral approach was employed to address the Volkmann fragment and fibula, ensuring distal screws were contained within the Volkmann fragment. A small posteromedial incision facilitated fixation of the posteromedial components. The final stage utilized an anterolateral approach to address the central joint injury and Chaput fragment.

The surgeon emphasized the importance of avoiding an anteromedial approach due to the transverse open wound location. Fixation of the medial side was completed during initial debridement to prevent further intervention in that area. Care was taken to ensure distal screws in the Volkmann fragment did not interfere with subsequent anterior reduction.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing initially, progressing to weight bearing as tolerated over several months. At four months postoperatively, weight-bearing lateral radiographs demonstrated maintained fracture alignment.

Follow up:   Not specified

Orthopaedic implants used:   External fixator, low-profile plates for Volkmann and fibula fixation, screws for Chaput and central joint stabilization.