| Indications |
- Provides safe exposure to
- medial (subcutaneous) border of the tibia
- lateral (extensor) surface of the tibia
- preferred approach to tibia unless the skin is compromised
- Indications
- ORIF of tibia fractures
- bone grafting for nonunion or delayed union
- implantation of electrical stimulators
- excision or biopsy of bone lesions
- osteotomy
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| Internervous Plane |
- None
- dissection carried epi-periosteal between tibialis anterior and tibia
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| Preparation |
- Anesthesia
- general
- sciatic or saphenous nerve blocks
- Position
- Tourniquet
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| Approach |
- Incision
- make a longitudinal incision 1 cm lateral to the anterior border of tibia
- length of incision depends on procedure, but the tibia may be exposed along its entire length
- Superficial dissection
- elevate skin flaps to expose the medial (subcutaneous) border of the tibia
- be sure to protect the long saphenous vein when retracting the skin flaps
- Deep dissection
- medial subcutaneous surface
- essential to minimize subperiosteal stripping
- incise periosteum longitudinally along the middle of the medial border
- reflect the periosteum anteriorly and posteriorly
- lateral extensor surface
- incise periosteum over anterior border of the tibia
- subperiostally dissect the tibialis anterior and retract it laterally
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Clinical Images |
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| Structures at Risk |
- Long Saphenous Vein
- is on medial side of calf and should be protected when raising a medial skin flap
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