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Anterolateral approach

Retraction of the tibialis anterior muscle should be limited

Retraction of the tibialis anterior muscle should be limited, to show only the essential part of the anterolateral surface of the tibia.

Near the junction of the middle and lower thirds of the tibia, the anterior compartment vessels (Anterior Tibial) and nerve (Deep Peroneal) come together and approach the lateral tibial surface. They wrap obliquely anteriorly and distally around the tibia. In the distal metaphyseal area, they lie on the periosteum, under the myotendinous portion of tibialis anterior, extensor hallucis longus, and extensor digitorum longus. If this exposure extends into the distal third of the tibia, the surgeon should identify and protect the neurovascular bundle. With care, it can be mobilized from the tibial surface, along with the anterior compartment muscles. This makes it possible to pass a plate more distally on the anterolateral surface, all the way to the ankle joint, if necessary.