Surgical Discussion

Patient positioning:  The patient was initially positioned prone for the direct posterior approach, and subsequently repositioned to supine for the anterolateral approach.

Anatomical surgical approach:  The direct posterior approach involved a midline incision with dissection through the popliteal fossa to access the posterior tibial plateau. The anterolateral approach involved a longitudinal incision over the lateral aspect of the knee, splitting the iliotibial band and performing subperiosteal elevation from Gerdy's tubercle to expose the lateral condyle.

The surgeon emphasized the importance of recognizing the full extent of the coronal shear fracture across the posterior plateau. A posteromedial approach was deemed inadequate for accessing this fragment, as it would not allow proper reduction on the lateral side. The chosen dual approach facilitated comprehensive access and reduction of both the coronal shear and lateral comminution.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing for 6 weeks, followed by gradual progression to partial weight bearing as tolerated. Range of motion exercises were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included locking plates and screws for stabilization of the tibial plateau fracture.