The open approach to the medial surface of the tibia is used for techniques requiring exposure of the tibial shaft and direct reduction.
It can also be used for an "Open-but-do-not-touch" approach. This allows visualization of the fracture and indirect reduction, without removal of the fracture hematoma and without manipulation of the fragments.
2. Anatomical considerations
The shape of the body of the tibia is triangular in its proximal portion, and circular to quadrilateral in its middle and distal parts.
3. Skin incision
A curved craniomedial skin incision is performed, starting over the medial tibial condyle proximally, following the cranial tibial margin distally, and curving caudally to the medial malleolus.
The flat medial side lies subcutaneously in its whole extent, it is bordered by the cranial tibialis muscle cranially, and the long digital flexor muscle caudally. The medial saphenous artery, vein and nerve cross the medial tibial surface in its central part in a caudoproximal to craniodistal direction.
The cranial tibial and medial digital flexor muscles can be retracted cranially and medially by incising the fascia along their borders. A Hohmann retractor can be used along the cranial and caudal aspect of the tibia to retract the muscle further laterally, in order to expose the tibial shaft.
The deep crural fascia and subcutaneous tissues are closed with continuous suture and routine closure of the skin.