The physeal fracture is exposed through a medial skin incision starting at the proximal metaphysis of the tibia and extending proximally to the distal epiphyseal level of the femur, thus centering along the medial collateral ligament of the femorotibial joint. The actual incision is located parallel and between the medial patellar ligament cranially and the medial collateral ligament of the femorotibial joint caudally.
2. Deep dissection
The underlying tissues are carefully incised to expose the medial aspects of the proximal tibial physis, to which the medial collateral ligament is attached, the separated physis and proximal tibial metaphysis.
Closure can be difficult because of limb swelling. Closed suction drain systems are used to reduce seroma formation. These devices are left in place unitl seroma formation significantly reduces approximately 3 - 4 days postoperatively. Stent bandages are recommended to reduce tension on the skin sutures.