Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the knee in a semi-extended position to facilitate both the fixation of the tibial tubercle and subsequent intramedullary nailing.

Anatomical surgical approach:  A longitudinal anterior approach was utilized to access the tibial tubercle. The incision extended from the patellar tendon insertion to the proximal tibia, allowing direct visualization and reduction of the tubercle fragment. Subperiosteal dissection was performed to expose the fracture site. The intramedullary nailing was performed through a standard entry point at the proximal tibia, ensuring that the nail path did not compromise the tubercle fixation.

The surgeon noted that all criteria for safely performing intramedullary nailing in the presence of a tibial tubercle fracture were met, including a simple fracture pattern, good bone quality, and successful anatomic reduction with interfragmentary compression. The fixation of the tubercle was achieved with implants positioned away from the nail path, allowing for safe passage of the intramedullary nail. The procedure was completed without intraoperative complications.

Postoperative protocol:   Postoperatively, the patient was advised to maintain non-weight bearing status on the affected limb for 6 weeks, followed by progressive weight bearing as tolerated. Range of motion exercises for the knee were initiated early to prevent stiffness, with a focus on achieving full extension and flexion.

Follow up:   Not specified.

Orthopaedic implants used:   Interfragmentary screws for tibial tubercle fixation, intramedullary nail for tibial shaft stabilization.