Surgical Discussion

Patient positioning:  The patient was positioned supine for the procedure.

Anatomical surgical approach:  Surgical access was achieved through direct medial and lateral approaches. The medial approach involved a curvilinear incision centered over the medial malleolus, carefully preserving the saphenous nerve and vein. The lateral approach entailed a straight incision over the lateral malleolus, with care taken to protect the superficial peroneal nerve.

Intraoperatively, the PTFL bony injury was noted alongside an anterior talofibular ligament (ATFL) tear, necessitating syndesmosis screw fixation proximal to the physis under fluoroscopic guidance. A 5-hole lateral plate was used to reduce and stabilize the Salter-Harris II fibular fracture with two distal locking screws. Medially, two screws were placed perpendicular to the fracture line; however, physeal sparing was not possible, resulting in two screws crossing the physis in the posteromedial aspect.

Postoperative protocol:   Postoperatively, the patient was placed in an ankle orthosis for six weeks.

Follow up:   Not specified.

Orthopaedic implants used:   Not specified.