Surgical Discussion

Patient positioning:  Not Specified

Anatomical surgical approach:  The surgical approach commenced with a longitudinal incision along the postero-lateral aspect of the distal tibia, extending proximally to allow adequate exposure. The intermuscular septum was identified and retracted, followed by subperiosteal dissection to expose the fracture site. Entrapped fragments were retrieved, and reduction was achieved in stages. A supplementary antero-medial incision was made to assist in reduction and fixation. The distal tibia was stabilized using a pre-contoured postero-lateral plate, and an additional lag screw was placed from antero-medial to postero-lateral through the epiphysis.

Intraoperatively, it was noted that fibula reduction played a key role in achieving satisfactory alignment of the tibial fracture. The presence of small avulsion fractures at the base of the 1st and 2nd metatarsals and subtle Lisfranc instability were addressed conservatively. The reduction was confirmed fluoroscopically, and fixation was deemed stable.

Postoperative protocol:   I do find that the posterolateral approaches do end up fairly stiff if you don’t get them moving early so for me now they all go into CAM boots or equivalent early and start ankle and STJ ROM.

Follow up:   Originally posted on LinkedIn by Simon Donald, Orthopaedic Surgeon, Bundaberg, Queensland, Australia

Orthopaedic implants used:   Pre-contoured postero-lateral plate, antero-medial to postero-lateral lag screw