Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a bolster under the ipsilateral hip to allow for external rotation of the limb, facilitating access to both the lateral and medial aspects of the ankle.

Anatomical surgical approach:  A longitudinal incision was made over the lateral aspect of the distal fibula, followed by subperiosteal dissection to expose the fracture site. A static tension band plate was applied to the fibula. Medially, a separate incision was made over the medial malleolus, and subperiosteal dissection was performed to expose the fracture and impacted plafond. A buttress plate was applied to stabilize the medial malleolus, and the articular impaction was reduced and fixed with screws.

The surgeon noted that the fibular fracture was highly distracted, necessitating careful tension band application to achieve stable fixation. The medial malleolar fracture required meticulous reduction due to significant articular impaction, which was addressed with multiple small fragment screws after buttress plating.

Postoperative protocol:   Postoperatively, the patient was placed in a short leg splint for immobilization. Non-weight bearing was advised for 6 weeks, followed by progressive weight-bearing as tolerated, with physiotherapy initiated at 8 weeks to restore range of motion and strength.

Follow up:   Not specified.

Orthopaedic implants used:   Static tension band plate for fibula, buttress plate for medial malleolus, small fragment screws for articular impaction fixation.