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.