Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table to facilitate intraoperative imaging and access to the lower extremity.

Anatomical surgical approach:  A longitudinal incision was made over the anteromedial aspect of the tibia for debridement and irrigation of the open fracture site. The proximal tibiofibular joint was approached laterally, with care taken to avoid iatrogenic injury to the common peroneal nerve. The tibial shaft was stabilized using an intramedullary nail inserted through a standard entry point at the proximal tibia.

The proximal tibiofibular joint dislocation was identified intraoperatively, requiring careful reduction to prevent long-term instability and dysfunction. The reduction was confirmed under fluoroscopy, ensuring proper alignment and stability of the joint. Given the complexity of the injury, a multidisciplinary approach involving both orthopaedic trauma and sports medicine specialists was considered for potential ligamentous reconstruction at a later stage.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing on the affected limb for 6 weeks, with gradual progression to partial weight bearing as tolerated. Early range of motion exercises were initiated to prevent joint stiffness, with close monitoring of neurovascular status.

Follow up:   Not specified.

Orthopaedic implants used:   Intramedullary nail, provisional plate fixation (specific implant details not provided).