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.
For a lateral approach, the incision is made between the long digital extensor and the cranial tibial muscles.
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.