Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table for both the initial debridement and subsequent fibular fixation.

Anatomical surgical approach:  A medial approach was avoided due to the location of the traumatic wound. Instead, a lateral approach was utilized for fibular fixation, involving an incision over the fibula with careful dissection to expose and reduce the fracture site.

The surgical team encountered significant challenges due to the absence of ligamentotaxis and reference fragments for reconstruction. The articular block was initially reconstructed too distally relative to the fibula, necessitating intraoperative adjustment. A suture anchor was used to recreate the anterior inferior tibiofibular ligament (AITFL), and a syndesmosis screw was placed into cement to stabilize the syndesmosis due to lack of intact tibial bone stock.

Postoperative protocol:   Postoperatively, the patient was placed in a non-weight-bearing status with a focus on maintaining range of motion exercises for adjacent joints. Weight-bearing status would be reassessed following definitive bone grafting and stabilization.

Follow up:   Not specified

Orthopaedic implants used:   External fixator, suture anchor for AITFL reconstruction, syndesmosis screw into cement, internal fixation for fibula (specific implant not detailed).