Surgical Discussion

Patient positioning:  The patient is positioned supine with the affected limb slightly flexed and externally rotated to facilitate access to the posteromedial aspect of the knee.

Anatomical surgical approach:  A posteromedial approach is utilized, involving an incision along the medial aspect of the knee. The pes anserinus is retracted anteriorly, and the medial collateral ligament is carefully preserved. Subperiosteal dissection is performed to expose the fracture site on the medial tibial plateau.

The surgeon noted the technical difficulty associated with this fracture type, emphasizing the challenge in achieving satisfactory reduction due to the complex fracture pattern and poor outcomes typically associated with such injuries. The reduction strategy focused on meticulous realignment of the articular surface and stabilization of the medial plateau.

Postoperative protocol:   Postoperative rehabilitation includes initial immobilization with a hinged knee brace, allowing controlled range of motion exercises starting at 2 weeks post-surgery. Weight-bearing is restricted to toe-touch for 6 weeks, progressing to partial weight-bearing as tolerated thereafter.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used include locking plates and screws for stabilization of the medial tibial plateau.