The anterolateral approach, through an incision slightly lateral to the tibial crest, reflects the anterior compartment muscles from the lateral tibial surface.
Medial approach, MIO
Minimally invasive fixation of tibial fractures is preferably done through the medial approach, especially for distal fractures.
Lateral approach, MIO
The lateral approach is used for minimally invasive osteosynthesis if the medial soft tissues are injured.
Intramedullary nailing approach
In the frontal plane, the entry point is located in line with the medullary canal (3 mm medial to the tibial crest). In the sagittal plane, the entry point should be located just distal to the angle between tibial plateau and anterior tibial metaphysis.
Safe zones for pin insertion
Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.
The posteromedial approach can be used for open plate fixation of the tibia on its posterior surface. Typically, this approach would be chosen, when direct exposure for ORIF is desired, but only the posteromedial soft tissues are safe to incise.
The posterolateral approach can be used for open plate fixation of the tibia on its posterior surface. This may be necessary when the anterior soft tissues are compromised.