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Posteromedial approach

Deep surgical dissection

Follow the fracture line to the posterior edge of the distal tibia. Open the crural fascia at the edge of the posterior tibia, proximally as far as necessary, and distally as far as the proximal insertion of the flexor retinaculum.

Retract the tendons of the tibialis posterior muscle and the flexor digitorum longus muscle and the posterior tibial neurovascular bundle, using blunt retractors.

Develop the dissection until the fracture line at the posterior part of the tibia is entirely in view.

Dissect the periosteum only as far as required for the control of the reduction at the metaphysis. If necessary, follow the fracture line anteriorly. Protect the saphenous nerve and vein.