Anterolateral Approach to Tibia

Indications

• middle 2/3 of tibia when anterior approach not suitable due to skin

Position

• Lateral
• Pad bony prominences

Landmarks

• Subcutaneous surface of fibula
• Fibula head
• Tibial shaft

Incision

• Straight longitudinal incision
• Over the shaft of the fibula

Internervous Plane

• Superficially
  • Peroneus brevis
    • Superficial peroneal nerve
  • Extensor digitorum longus
    • Deep peroneal nerve
• Deep
  • Tibialis posterior
    • Tibial nerve
  • Extensors of ankle & foot
    • Deep peroneal nerve

Superficial Dissection

• deepen the incision
• taking care not to dam age the
  • short saphenous vein in the posterior aspect of the wound
• incise fascia
• identify the underlying peroneal muscles
• develop a plane between peroneus brevis & EDL
• taking care not to damage the
  • superficial peroneal nerve

Deep Dissection

• gently detach the extensor musculature from the anterior aspect of the interosseous membrane
• follow the anterior aspect of the membrance onto the lateral border of the tibia

Dangers

• Nerves
  • Superficial peroneal nerve
• Vessels
  • Small saphenous vein