Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with a tourniquet applied to the proximal thigh to maintain a bloodless field during the procedure.

Anatomical surgical approach:  A longitudinal anterior incision was made over the proximal tibia. The patellar tendon was exposed, and a Krackow suture technique was employed using #5 Fiberwire along the full length of the tendon. The suture was then passed through a diaphyseal bone tunnel and secured to the plate to stabilize the tibial tubercle avulsion.

The surgeon noted the critical importance of achieving a stable repair of the extensor mechanism due to the minimal bone stock available at the tibial tubercle. Traditional plating was not feasible; thus, Fiberwire was utilized exclusively for fixation. The extra-articular nature of the tibial fracture obviated the need for a submeniscal arthrotomy. Despite initial concerns regarding potential failure of the extensor mechanism repair, the patient demonstrated successful healing without extensor lag at six months postoperatively.

Postoperative protocol:   Postoperative rehabilitation included immobilization in extension for initial healing, followed by gradual range of motion exercises. Weight-bearing was restricted initially, with progression based on clinical and radiographic evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   #5 Fiberwire