42 ANTEROLATERAL APPROACH TO THE TIBIA USES This approach is used for fracture reduction and fixation and for posterior to anterior tendon transfers. ADVANTAGES This extensile exposure is in a safe area and can be carried as far proximally or distally as necessary. DISADVANTAGES This approach does not provide any access to the posterior lower leg. Also, to access the medial aspect of the tibia, it requires a longer incision. Exposing the tibia for fracture fixation with this approach also strips its periosteal blood supply coming from the lateral side. STRUCTURES AT RISK The only structures at risk are the dorsalis pedis artery and the deep peroneal nerve. In the proximal half of the tibia, the structures are well protected by the muscles. They come close to the tibia in the distal half of the tibia (see Fig. 45–4) and can be damaged with indiscriminate stripping of the muscle off of the tibia. If you are doing this procedure for a posterior to anterior tendon transfer, then you need to realize that the communicating peroneal artery runs along the posterior aspect of the interosseous membrane and can be damaged when the membrane is opened. You must be aware of that possibility and be sure to cauterize the ends of the blood vessels if they are seen. TECHNIQUE A straight incision is made generally 1 to 2 cm lateral to the tibial crest. This then leaves a muscular bed under the incision in case there are any wound healing problems. The fascia overlying the musculature is split as far as necessary proximally or distally to provide good exposure or to release the compartment. Once the fascia is split, the musculature can be mobilized laterally, exposing the tibia. Distally, the artery and nerve will exit the muscle and may actually lie on the tibia, rather than within the muscle belly. They need to be separated from the tibia before doing any probing or instrumentation along the lateral aspect of the tibia.
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