Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected leg draped freely to allow for intraoperative manipulation and fluoroscopic imaging.

Anatomical surgical approach:  A combined anterolateral and posteromedial approach was utilized to access the tibial plateau. The anterolateral approach involved a longitudinal incision over the lateral aspect of the knee, with careful dissection to expose the lateral tibial plateau. The posteromedial approach provided access to the medial plateau, allowing for comprehensive management of the bicondylar fracture.

Intraoperative reduction of the posterior lateral tibial plateau was achieved using a tamp under fluoroscopic guidance. Subchondral wires were pre-positioned to provisionally fix the elevated fragments, followed by placement of raft screws for definitive fixation. The metaphyseal component was managed with an IM nail, chosen for its biomechanical equivalence to dual column plating and its advantage in preserving soft tissue integrity.

Postoperative protocol:   Postoperatively, immediate knee range of motion exercises were initiated. Partial weight-bearing was commenced at 4 weeks, with progressive weight-bearing as tolerated, adhering to AO principle 4 of early motion.

Follow up:   Not specified.

Orthopaedic implants used:   Subchondral wires, raft screws, intramedullary nail.