Fig. 1

a Positions of anterolateral and medial midline incisions. b Z-shaped deep periosteal incision. *Distal attachment of the MCL to the tibia. **Pes anserinus. ***Posteromedial capsule. ****Tibia plateau. c Solid arrow: Distally displaced posterior column fracture. Dotted arrow: Drill hole used to elevate the lateral column fracture and shuttle the sutures for ACL avulsion fracture. d Plate buttressing of the posterior column. In this case, the posterior column was also fixed to the plate as medial and lateral columns were intact. e Posteromedial capsule and pes anserinus sutured in an anatomical fashion. The MCL tibial attachment was not dissected from its insertion. In the case of medial plating for a medial column fracture, the plate was positioned proximally on the MCL and distally under the pes anserinus