Surgical Discussion

Patient positioning:  The patient was positioned in a semiextended position for the procedure, facilitating a supra-patellar approach for nail insertion.

Anatomical surgical approach:  A supra-patellar approach was utilized for intramedullary nailing. The entry point was established through the patellar tendon, and the nail was inserted through the proximal tibia into the medullary canal. Reduction of the tibial fracture was achieved using two percutaneously applied large Weber clamps prior to nail insertion.

The surgeon opted for intramedullary nailing due to the ability to achieve stable fixation with three distal interlocking bolts in a short segment of the tibia. This choice was based on the biomechanical superiority of nails in long bone fractures. The medial malleolar fracture was left unfixed due to its non-displaced nature. The fibula was not addressed surgically, as it was not fractured or deemed necessary for stabilization.

Postoperative protocol:   The postoperative rehabilitation protocol included early weight-bearing, allowing the patient to walk at 2 weeks post-surgery. This approach contrasts with a plating strategy, which would have required non-weight bearing for at least 6 weeks.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail with three distal interlocking bolts.