Surgical Discussion

The initial surgical approach commenced medially where a good read of the medial column allowed anatomical reduction of the medial column with a short monocortical 3.5 millimetre plate. This provided a basis to then reconstruct the lateral column before attending to articular reduction of the lateral joint surface. As the medial side was the primary reduction axis the medial column was supported full length allowing loads to transfer distally into the diaphysis. The medial approach was kept small and distal plate fixation was done in a minimally invasive fashion. The lateral approach was a classical incision over the lateral aspect of the anterolateral tibia to the lateral femoral epicondyle with a classical ITB split and submeniscal arthrotomy the joint was reduced under direct vision with fragment specific subchondral screw fixation from the posterolateral corner before anterolateral plating. The proximal locking screws worked as a rafting construct, supporting the lateral plateau. The lateral column was reconstructed and fixed to the diaphysis. Given the degree of depression in the lateral plateau a a period of partial weight bearing was followed before full weight bearing at 8 weeks.

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