Approach: A J-shaped incision curving anteriorly (Fig. 2.2) was used over the medial malleolus to gain access to the medial malleolus and the anteromedial corner of the tibial plafond.

Fracture reduction and fixation: A small-incision arthrotomy was done in the anteromedial part of the tibial plafond to allow a small curved mosquito forceps to be passed in to feel for the depressed fragment. The depressed fragment was elevated through the fracture site under fluoroscopic guidance and the fracture was reduced using a clamp. K-wires were used to provisionally hold the reduction. Reduction was confirmed on fluoroscopy and by feeling for the depressed fragment using a curved mosquito forceps. A T-plate was used in antiglide mode for fixation with the lower screws acting as raft screws subchondrally (Fig. 2.3).

A short leg splint was placed for 3 days for comfort and pain control. Range-of-motion exercises were started after 3 days. The patient remained non-weight bearing for 6 weeks after which partial weight bearing was started.

At 12 weeks, the patient was full weight bearing and had resumed household ambulation.

Follow-up radiographs at 12 weeks show healed fracture. She had residual swelling which took another 6 weeks to disappear completely. Patient returned to full function at 6 months with full ankle motion.