Surgical Discussion

Patient positioning:  Supine positioning on the operating table with appropriate padding to maintain limb alignment and facilitate surgical access.

Anatomical surgical approach:  The existing open wound over the anterolateral aspect of the leg was extended as needed to access the tibial diaphysis and the dislocated proximal fibula. Subperiosteal dissection was carried out to expose the fracture site. The intercalary tibial fragment was utilized temporarily to assist in anatomical reduction during intramedullary nailing

Completely devitalized segments of bone shouldn’t be discarded right away—they can still serve a critical role in achieving anatomical reduction. In this case, the intercalary tibial fragment, although devitalized, was temporarily used to facilitate anatomical alignment during intramedullary nailing and subsequently discarded. Once its role was complete, the segment was removed and the defect managed using the Masquelet technique. A polymethylmethacrylate (PMMA) spacer was placed to address the bone void, with plans for autografting at six weeks postoperatively. The proximal tibiofibular dislocation was also stabilized."

Postoperative protocol:   Postoperative protocol included immobilization with limited weight-bearing on the affected limb. Progressive weight-bearing was anticipated following soft tissue healing and subsequent autografting.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail for tibia and fibula, PMMA spacer, fixation devices for proximal tibiofibular dislocation.