Surgical Discussion

Operation was performed around 10 to 14 days post injury following subsidence of post-operative swelling. Patient was placed in a simile lateral position within me Drake freely and a carbon roll placed under the medial aspect of the distal allowing the link to fall into varus. A direct lateral incision was made over the fibula head and lateral epicondyle as indicated in the attached images. To working windows for established one 1-in the classical anterolateral position with sub meniscal arthrotomy demonstrating a limited view of the the lateral tibial plateau. A second window was created posteriorly. This window is between the poster aspect of the biceps tendon and peroneal nerve and the medial head of gastrocnemius. Careful dissection down to the post urea aspect of the joint line is achieved with proximal medial retraction of the Billy of popliteus. The lateral genicular artery was identified and preserved. Sharp debridement of the lateral aspect of solis from the bone was done offering good direct visualisation of the bony tibial joint margin. As can be appreciated from these intra-operative photos the working window is relatively small. Visualisation of reduction is difficult. Nonetheless we achieved an anatomical reduction of the joint depression, and filled the the defect with hello plastic bone replacement material. The atukula surface was rafted with two 4.0 mm cannulated screws and then buttressed posteriorly with a modified 2.7 mm distal radial t plate. The the long limb of the t plate needs to be placed carefully distally taking into consideration the fibrous arch of soleus and the branching of the popliteal artery into the anterior or posterior tibial arteries passing through this region.