Posterolateral Approach



- ORIF distal 2/3 tibia 

- bone grafting tibial non-unions

- also permits exposure to posterior aspect of fibula





- lateral position or prone



- fibular shaft and ankle joint



- longitudinal incision 2cm behind the fibula


Internervous plane 

- between posterior & lateral compartments

- anterior - peroneus muscles

- posterior - gastrocnemius, soleus & FHL (distal)


Superficial dissection

- dissect T achilles (gastroc and soleus) posteriorly and peronei muscles anteriorly

- muscular branches of peroneal artery lie with peroneus brevis in proximal part of incision / ligated


Deep dissection

- detach lower part of soleus & FHL from fibula

- continue dissecting across the interosseous membrane, detaching tibialis posterior from it

- follow interosseous membrane to lateral border of tibia

- detaching tibialis posterior from posterior surface of tibia subperiosteal

- posterior tibial artery & tibial nerve are posterior to dissection on tibialis posterior



- peroneal artery - branches cross inter-muscular plane bt gastrocnemius & peroneus brevis 

- posterior tibial artery & tibial nerve - safe as long as dissection stays on interosseous membrane

- short saphenous vein - may be damage in mobilizing skin flaps


Extensile measures

- proximal - cannot be extended into proximal 1/4 of tibia as it is covered by popliteus

- distal - continuous with posterior approach to ankle


Anterolateral approach



- exposes middle 2/3 tibia

- technically simple, but only provides limited exposure to tibia for ORIF

- anterolateral bone grafting tibial non-unions





- lateral position or supine with sandbag under hip



- longitudinal incision over the shaft of fibula

- length of tibia exposed will be considerably shorter than length of fibula incision


Internervous plane

- between peroneus brevis (posterior) & EDL (anterior)


Superficial dissection

- develop plane between anterior border of peroneus brevis & EDL 

- expose anterior aspect of tibia

- protect superficial peroneal nerve which lie on peroneus brevis muscle


Deep dissection

- subperiosteal dissection extensor muscles from anterior surface of interosseous membrane 

- extend onto lateral surface of tibia

- only endanger neurovascular bundle if sway off interosseous membrane



- SPN - motor branches given off proximal 1/3 then only sensory distally

- anterior tibial artery & DPN


Extensile measures 

- cannot be extended easily proximally or distally