Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table to facilitate intraoperative imaging and access to the distal tibia.

Anatomical surgical approach:  An anterolateral approach to the distal tibia was utilized, involving an incision over the fibula and extending distally to the ankle joint. Subperiosteal dissection was performed to expose the fracture site, allowing for direct visualization and reduction of the articular fragments. Intramedullary nailing was performed for the diaphyseal extension, and fragment-specific fixation was applied to the articular surface.

The surgeon emphasized the importance of achieving accurate joint reduction, maintaining length, alignment, and rotation, and providing a mechanical environment conducive to union with a durable construct. The procedure involved a combination of relative and absolute stability principles, integrating intramedullary nailing with plate fixation to address both diaphyseal and articular components effectively.

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

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, small buttressing plates, interlocking bolts.