Safe zone in the distal tibia
When inserting Schanz screws in the distal zone consider the position of the anterior tibial artery and vein. Percutaneous insertion of Schanz screws in this area is dangerous. A minimal incision will allow preparation and safe insertion.
Schanz screws at this level should be inserted as shown in the illustration from anterior to posterior. Use small retractors to protect neurovascular structures and extensor tendons.
A second Schanz screw can be inserted from medial to lateral, medial to the tibialis anterior tendon.