Surgical Discussion

Anatomical surgical approach:  An extended anteromedial approach was utilized for both sides. A longitudinal incision was made along the anteromedial aspect of the tibia, extending from the distal third of the tibia to the talar neck. The incision was deepened through the subcutaneous tissue and fascia, taking care to protect the saphenous vein and nerve. The periosteum was elevated subperiosteally to expose the fracture site. For the right side, additional iliac crest bone grafting was performed to address bone loss.

The surgeon noted that the extended anteromedial approach provided excellent exposure for both fractures. The large iliac crest bone graft on the right side incorporated well into the fracture site. Temporary TPN dysfunction was observed following the accident but resolved fully within three months. The soft tissues on the open side also recovered well.

Postoperative protocol:   Postoperatively, the patient was advised to avoid weight-bearing on both lower extremities for six weeks, followed by partial weight-bearing as tolerated. Range of motion exercises for the ankle joint were initiated early to prevent stiffness. Full weight-bearing was allowed at three months postoperatively.

Follow up:   Not specified. Case originally posted on LinkedIn by : Erik Hasenboehler MD FACS - Chief of Orthopaedic Trauma Holy Spirit Hospital Penn State Health Orthopaedic Institute of Pennsylvania

Orthopaedic implants used:   - External Fixator - Vancomycin Powder - Iliac Crest Bone Graft - Stryker Variax Plates and Screws