Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table. A tourniquet was applied to the proximal thigh, and a radiolucent table was used to allow intraoperative imaging.

Anatomical surgical approach:  A direct anterior approach to the proximal tibia was utilized. An incision was made over the anterior aspect of the tibia, extending from the level of the tibial tubercle distally. The patellar tendon was retracted laterally to expose the fracture site. Subperiosteal dissection was performed to visualize the fracture fragments, particularly focusing on the tibial tubercle.

The tibial tubercle was addressed first to ensure stability for early motion postoperatively. Reduction was achieved using direct manipulation and temporarily held with K-wires. Definitive fixation was accomplished using a plate, which also facilitated fine-tuning of the overall reduction of the proximal tibia fracture. Care was taken to avoid malreduction, which can occur with intramedullary nailing in this fracture pattern.

Postoperative protocol:   Postoperative rehabilitation included early range of motion exercises to prevent knee arthrofibrosis. Weight-bearing as tolerated was initiated immediately post-surgery, with progression based on clinical and radiographic healing.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used: Plate fixation system for proximal tibia, K-wires for temporary stabilization.