Posterolateral Approach to the Tibia

  • The posterolateral approach to the Tibia is used to expose the middle two thirds of the tibia when the skin over the subcutaneous surface is badly scarred or infected.

  • The Posterolateral Approach to the Tibia uses include the following:
    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.
    6. Fibula resection for fibula transfer.

  • Prone or lateral position.

  • Landmarks:
    1. Gastrocnemius muscle.
  • Incision:
    • Make a longitudinal incision over the lateral border of the gastrocnemius muscle.

  • The Internervous plan for the Posterolateral Approach to the Tibia lies between:
    1. Tibial nerve (posterior compartment) which innervates:
      • Gastrocnemius  muscle.
      • Soleus muscle.
      • Flexor hallux longus muscle.
    2. Superficial peroneal nerve (lateral compartment) which innervates:
      • Peroneus brevis muscle
      • Peroneus longus muscle.

  • Reflect skin flaps:
    • Take care not to damage the short saphenous vein.
  • Incise fascia:
    • Incise in line with the incision.
  • Develop intermuscular plane:
    • Develop plan between the gastrocnemius and soleus (posterior group) and peroneal muscles (lateral group).
    • Muscular branches of peroneal artery lie with peroneus brevis proximally and may need to ligated.
  • Retract the soleus and gastrocnemius muscles posteromedially:
    • Once done identify the origin of Flexor hallux longus and soleus muscles on the posterior border of the fibula.

  • Detach the Flexor hallux longus and soleus muscles.
    • Detach from the posterior border of the fibula and retract posteromedially.
    • May expose entire length of fibula.
  • Detach posterior tibialis muscle:
    • Remove off the posterior surface of the interosseous membrane.
    • The posterior tibial artery and nerve will be posterior to posterior tibialis and Flexor hallux longus.
  • Follow Interosseous membrane to tibia:
    • Follow the posterior surface of the interosseous membrane to the lateral border of the tibia.
  • Release posterior tibialis and Flexor digitorum longus of tibia:
    • Dissect the posterior tibialis and flexor digitorum longus off the posterior surface of the tibia to expose the desired segment of tibia.

  • Proximal Extension:
    • The Posterolateral Approach to the Tibia cannot be extended into the proximal fourth of the tibia,
      • Popliteus muscle, posterior tibial artery, and tibial nerve prevent proximal dissection.
  • Distal Extension:
    • The Posterolateral Approach to the Tibia may be extended distally to become continuous with the posterior approach to the ankle.

  • The structures at risk during the Posterolateral Approach to the Tibia include:
    1. Short saphenous vein.
    2. Peroneal artery and branches:
      • avoid injury by staying on the posterior surface of the interosseous membrane.
      • branches may be ligated and coagulated.
    3. Posterior tibial artery and nerve :
      • avoid injury by staying on the posterior surface of the interosseous membrane.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Posterolateral Approach to the Tibia Posterolateral Approach to the Tibia Posterolateral Approach to the Tibia Posterolateral Approach to the Tibia Posterolateral Approach to the Tibia 5 tibia Posterolateral Approach Posterolateral Approach to the Tibia Posterolateral Approach to the Tibia
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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