Medial 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 medial approach provides the easiest access to the bone/fracture, but has the disadvantage that there is no muscle coverage, which would better facilitate fracture healing and to some extent limit the development of postoperative infection.

The incision is made along the medial border of the cranialis tibialis muscle. Care is taken to avoid injury to the saphenous vein.

The skin and subcutaneous tissue is incised.

A penrose drain is used to isolate and retract the saphenous vein (red arrow) and the soft tissues are retracted to expose the medial tibia. Minimal dissection of the periosteum is recommended.

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.