The anterolateral approach is useful in the majority of complete articular pilon fractures, anterior and anterolateral partial articular pilon fractures, and some extraarticular distal tibia fractures.
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.
A direct medial approach can be used for vertical medial split fractures with associated articular impaction.
Minimally invasive approach
This MIO approach is used for extraarticular fractures, or for simple, minimally displaced, complete articular fractures.
The posteromedial exposure allows direct reduction of posterior and medial fracture fragments.
The nail entry point is on the anterior edge of the tibial plateau, missing the menisci, and centered over the medullary canal on the AP view.
When inserting Schanz screws in the distal zone consider the position of the anterior tibial artery and vein. Percutaneous insertion of Schanz screws or pins in the distal tibia is dangerous.