Surgical Discussion

Patient positioning:  Supine position on a radiolucent table, allowing for intraoperative imaging and access to both the medial and lateral aspects of the lower extremity.

Anatomical surgical approach:  A medial approach to the distal tibia was utilized. A longitudinal incision was made over the medial aspect of the distal tibia, followed by careful dissection to expose the fracture site. Subperiosteal elevation was performed to allow for placement of the plate.

The surgeon noted significant residual varus after initial reduction attempts using fibular fixation. An undercontoured medial plate was employed to push the articular block out of varus in a controlled manner, serving as an indirect reduction technique. This approach allowed for correction of the deformity that could not be achieved with a nail alone.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing initially, with progression based on radiographic healing and clinical assessment. Emphasis was placed on early range of motion exercises to prevent stiffness.

Follow up:   Not specified

Orthopaedic implants used:   Medial tibial plate, fibular fixation screws