Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table to facilitate access to the posteromedial aspect of the distal tibia.

Anatomical surgical approach:  A posteromedial approach was utilized, providing direct access to the distal tibia and articular fragments. The surgical exposure allowed for direct reduction of each fracture component: the distal tibia was addressed first, followed by the medial articular fragment, and finally the Volkmann fragment.

The surgeon opted for direct reduction of each fracture line, initially using clamps which were subsequently replaced with 2.4 mm interfragmentary screws in the diaphysis. Three separate anti-glide plates were applied, each positioned over the apex of the respective fracture lines to create a stable construct and prevent shear displacement. The approach adhered to AO Basic principles, simplifying the fixation strategy.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing status initially, with gradual progression to partial weight bearing as tolerated. Range of motion exercises were initiated early to maintain joint mobility.

Follow up:   Not specified.

Orthopaedic implants used:   2.4 mm interfragmentary screws, anti-glide plates.