2. Use of an external fixator, open reduction,
fibular osteotomy and rodding
3. steps
• Apply an external fixator and attach 2 femoral distractors
• Anterolateral incision over the anterior compartment
• Expose the tibia facture and the fibula after doing a generous
fasciotomy, 1 cm fibulectomy
• Mobilize the fracture
• Lengthen the fracture
• Reduce the fracture as anatomically as possible
4. steps
• Ream the proximal fragment, don’t ream the distal fragment
• Place the rod down to the fracture
• VERY slowly advance the nail while maintain anatomic reduction
• Take off the fixator and allow compression of the fx
• Lock distally
• Check for rotational stability
• Don’t lock proximally if you can avoid it
• Use your fibula to bone graft the tibia