Cranial approach to tibial shaft

Approaches to the tibia for diaphyseal fracture repair must take the following anatomy into consideration. The cranial tibial artery is located on the cranial lateral aspect of the tibia. The lateral outpouching (sulcus muscularis) of the lateral femorotibial joint compartment extends distally, surrounding the long digital extensor tendon on the proximolateral aspect of the tibia. The tenuous soft tissue on the medial aspect of the tibia must be protected and the closely attached digital extensor tendons distally near the tarsocrural joint must be avoided.

The cranial approach eliminates the necessity of dealing with any blood vessels, because all the vasculature is elevated with the cranial tibial muscle.

The incision is initiated craniolaterally along the lateral patellar ligament, extended to the tibial crest, directed craniad over the cranial tibial muscle to the distal aspect of the limb, and curved slightly medially as the tarsocrural joint is approached.

The incision is carried through the skin and subcutaneous fascia until the cranial tibial muscle is encountered. The cranial tibial muscle is elevated laterally exposing the lateral surface of the bone.

Closed drain suction is recommended for 24-48 hours to prevent seroma formation. The subcutaneous tissue and skin is closed routinely and a sterile stent bandage is applied.