Anteromedial or anterolateral approach to the distal tibia?
This page gives guidelines to decide between an anterolateral or an anteromedial approach.
Anterolateral approach to the distal tibia
The anterolateral approach is useful for many complete articular pilon fractures, anterior and anterolateral partial articular pilon fractures, and some extraarticular distal tibia fractures stabilized with a submuscular anterior compartment plate.
Anteromedial approach to the distal tibia
Posteromedial approach to the distal tibia
The posteromedial exposure allows direct reduction of posterior and medial fracture fragments. A posterior plate can be placed, effectively buttressing the posterior fragments. A full thickness subcutaneous anteromedial flap can be created to allow exposure and fixation of the medial malleolus if necessary.
Minimally invasive approach to the distal tibia
This MIO approach is used for extraarticular fractures, or for simple, minimally displaced, complete articular fractures. In the latter, the articular fracture component is not exposed, and is reduced either by indirect maneuvers using ligamentotaxis, or by the application of percutaneous reduction forceps, or directly by the percutaneously inserted lag screws.
Medial approach to the distal tibia
A direct medial approach can be used for vertical medial split depression fractures with associated articular impaction. However, the risk of leaving the plate directly under the medial incision should be considered. Alternatively, the incision can be anteromedial. These fractures frequently have impaction and comminution where the fracture enters the joint. Frequently there is an independent...
Posterolateral limited open approach to the distal tibia
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 has the advantage of allowing fixation of both the fibula and tibia through the same incision. It is also useful when the soft-tissue injury prevents use of the anterolateral or anteromedial exposures.
Safe zones of the tibia
This page comprises details on safe zones for pin insertion in the lower half of the tibia shaft, the distal tibia, the calcaneus, and the metatarsals.
Nailing limited open approach to the distal tibia
A detailed description of the limited open approach to the distal tibia for nailing.
