Executive Editor: Jörg Auer

Authors: Alan Ruggles


back to skeleton


Approach to the proximal tibia

The physeal fracture is exposed through a medial skin incision starting at the proximal metaphysis of the tibia and extending proximally to the distal epiphyseal level of the femur, thus centering along the medial collateral ligament of the femorotibial joint. The actual incision is located parallel and between the medial patellar ligament cranially and the medial collateral ligament of the femorotibial joint caudally.

Approach to tibial crest

A medial based slightly curved incision is made over the cranial aspect of the tibia. The incision originates at the level of the  distal femur and extends distally to the proximal one third of the tibia.

Lateral approach to tibial shaft

Approaches to the tibia for diaphyseal fracture repair must take the following anatomy into consideration. The cranial tibial artery is located on the cranial lateral aspect of the tibia.

Cranial approach to tibial shaft

The incision is initiated craniolaterally along the lateral patellar ligament, extended to the tibial crest, directed craniad over the cranial tibial muscle to the distal aspect of the limb, and curved slightly medially as the tarsocrural joint is approached.

Medial approach to tibial shaft

The medial approach provides the easiest access to the bone/fracture, but has the disadvantage that there is no muscle coverage, which would better facilitate fracture healing and to some extent limit the development of postoperative infection.

The incision is made along the medial border of the cranialis tibialis muscle. Care is taken to avoid injury to the saphenous vein.

Access to the medial malleolus

Medial malleolar fractures are usually reduced closed and the implants are placed through stab incisions.

Fractures of the lateral malleolus are mostly treated by resection of the fragments under arthroscopic control.
More details are described within the procedures.

v1.0 2013-12-01