Surgical Discussion

Patient positioning:  The patient was positioned supine

The surgery commenced with a medial approach to the tibia. The deformity tended into valgus due to a lateral tibial defect. An open reduction was performed, and provisional fixation achieved with K-wires. A 3.5mm locking compression plate (LCP) was precontoured to match the profile of the tibia, ensuring anatomical alignment by comparing it intraoperatively to the contralateral side. The fracture was reduced to the plate with cortical screws, which were then exchanged for locking screws. The fibula, which did not reduce with the tibial reduction, was addressed through a lateral approach. Disimpaction and reduction of fibular fragments were achieved, followed by stabilization with a 3.5mm one-third tubular plate.

Reflecting on the operation, the dual approach allowed for effective management of both the tibial and fibular fractures. The additional lateral approach for the fibula offered secuirty in addressing the tendency to valgus deformity. Comparing the injured leg's alignment to the uninjured side intraoperatively was a necessary step to achieving a satisfactory anatomical outcome.

Postoperative protocol:   Postoperatively, no cast or splint was applied, allowing for early mobilization. The patient was advised toe weight-bearing (TWB) for 6 weeks.

Follow up:   ROH in 9 months

Orthopaedic implants used:   3.5mm LCP plate for the tibia, 3.5mm one-third tubular plate for the fibula