Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table, allowing for bilateral access and imaging.

Anatomical surgical approach:  Right Side: A percutaneous approach was utilized for the medial plating, with indirect reduction achieved through distraction techniques. Left Side: Percutaneous clamping was employed to stabilize the fracture during intramedullary nailing.

The right tibia presented a challenge due to its comminuted nature, necessitating reliance on indirect reduction techniques with a distractor. The fibula served as a crucial guide for alignment. The surgeon emphasized the importance of understanding nail characteristics, such as bolt distance and location relative to the fracture, when choosing intramedullary fixation. A percutaneous medial plate was added for additional stability due to the patient's size. On the left side, successful percutaneous clamping prevented displacement during nail deployment. The surgeon noted that maintaining an intact lateral column by addressing the fibula can prevent valgus displacement, although it was not required in this case.

Postoperative protocol:   Early mobilization with weight-bearing as tolerated was encouraged, with progression based on clinical and radiological healing.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, percutaneous medial plate, distractor device.