Anterior Approach to Tibia

  • The anterior approach to tibia bone offers safe, easy access to the medial (subcutaneous) and lateral (extensor) surfaces of the tibia.

  • The anterior approach to tibia bone is used for:
    1. Open reduction and internal fixation of tibia fractures
    2. Bone grafting for nonunion or delayed union
    3. Implantation of electrical stimulators
    4. Excision or biopsy of bone lesions
    5. Osteotomy.

  • Place the patient supine.

  • Landmarks:
    1. Shaft of the tibia.
  • 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.

  • There is No Internervous plane for the anterior approach to tibia bone.
  • Dissection carried epi-periosteal between tibialis anterior muscle and tibia bone.

  • 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.

  • 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 muscle and neurovascular bundle and retract laterally.

  • Proximal Extension:
    • The anterior approach to tibia can be extended proximally by continue the skin incision along the medial side of the patella.
    • Deepen the incision through the medial patellar retinaculum to gain access to the knee joint and the patella.
  • Distal Extension:
    • To extend the approach distally, curve the incision over the medial side of the hindfoot.
    • Deepening the wound provides access to all the structures behind the medial malleolus.

  • The structures at risk during anterior approach to tibia include:
    • Long Saphenous Vein
      • It’s located on medial side of calf.
      • Should be protected when raising a medial skin flap.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
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