Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with a radiolucent table used to facilitate intraoperative imaging. A bump was placed under the ipsilateral hip to allow for slight external rotation of the limb.

Anatomical surgical approach:  The surgical approach included a posteromedial incision along the medial border of the tibia, with careful dissection to protect the saphenous nerve and vein. Subperiosteal elevation was performed to expose the posteromedial aspect of the tibia for plate placement. An anterolateral incision was made, extending from Gerdy's tubercle distally, splitting the iliotibial band and performing a sub-meniscal arthrotomy for visualization of the lateral plateau.

The surgeon emphasized the importance of avoiding varus malalignment during fixation. Careful attention was given to restoring the mechanical axis of the limb. Articular reduction was achieved as much as possible, but it was considered secondary to achieving correct alignment. Compartment pressures were monitored intraoperatively due to the high-energy nature of the injury.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing for 6 weeks, followed by progressive weight bearing as tolerated. Range of motion exercises were initiated early to prevent stiffness, with a focus on achieving full extension and flexion.

Follow up:   Not specified.

Orthopaedic implants used:   Posteromedial plate, anterolateral plate.