Surgical Discussion

Patient positioning:  Prone positioning was selected for optimal access to the posterior aspect of the tibial plateau.

Anatomical surgical approach:  A posteromedial approach was utilized. The incision was made along the medial border of the tibia, with careful dissection through the subcutaneous tissue and fascia. The medial head of the gastrocnemius muscle was retracted laterally to expose the posterior aspect of the tibial plateau. Care was taken to protect the neurovascular structures in proximity.

The surgeon noted that the lateral displacement of the posterior column required meticulous reduction and stabilization. Interfragmentary compression was achieved using lag screws at the articular surface, followed by buttress plating at the apex to provide stability. The reduction was confirmed intraoperatively with fluoroscopy.

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

Follow up:   Not specified

Orthopaedic implants used:   Buttress plate, lag screws