Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia

Minimally invasive osteosynthesis (MIO) of the proximal tibia is particularly useful for extra-articular or simple metaphyseal fractures where preserving soft tissue and periosteal blood supply is critical.

Note: Articular reduction must be checked arthroscopically because the joint cannot be visualized directly through the small incision of a minimally invasive approach.

Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia, skin incision

AO teaching video: MIO tibia, proximal

anterolateral approach

Identify Gerdy’s tubercle. Make a straight incision about 5 cm in length starting posteriorly to Gerdy’s tubercle and running distally and anteriorly.

Open the deep fascia starting at Gerdy’s tubercle and extend it distally. Expose the bone by releasing the anterior attachment of tibialis anterior.

Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia, opening the fascia

To control the articular reduction, insert an arthroscope through a medial portal. You cannot make an adequate arthrotomy laterally through the small lateral incision of a minimally invasive approach.