Executive Editor: Peter Trafton

Authors: Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle

Distal tibia

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Anteromedial approach

This approach is used for open reduction and internal fixation of the articular part of the tibia. It facilitates accurate articular reduction combined with submuscular and subcutaneous plate applications.

Anterolateral approach

The anterolateral approach is useful in the majority of complete articular (type 43C) pilon fractures, anterior and anterolateral partial articular (type 43B) pilon fractures, and some extraarticular distal tibia fractures.

Posteromedial approach

The posteromedial exposure allows direct reduction of posterior and medial fracture fragments.

Medial approach

A direct medial approach is usually used for vertical medial split fractures with associated articular impaction (43-B2 fractures).

Minimally invasive approach

This MIPO approach is used for extraarticular type A fractures, or for simple, minimally displaced, intraarticular type C fractures.

Posterolateral approach

This approach lends itself to fracture patterns that are primarily displaced fractures of the posterior tibia with little or no involvement of the anterior tibial surface. It allows fixation of both the fibula and tibia through the same incision.

Nailing approach

The entry point is on the anterior edge of the tibial plateau, missing the menisci, and centered over the medullary canal on the AP view.

Safe zones

When inserting Schanz screws in the distal zone take into account the position of the anterior tibial artery and vein. Percutaneous insertion of Schanz screws or pins in the distal tibia is dangerous.

v1.0 2008-12-03