Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia
1. Principles
Articular reduction must be checked arthroscopically because the joint cannot be visualized directly through the small incision of a minimally invasive approach.
2. Teaching video
AO teaching video: MIO Tibia, Proximal
Anterolateral Approach
3. Skin incision
Identify Gerdy’s tubercle. Make a straight incision about 5cm in length starting posteriorly to Gerdy’s tubercle and running distally and anteriorly.
4. Opening the fascia
Open the deep fascia starting at Gerdy’s tubercle and extend it distally. Expose the bone by releasing the anterior attachment of tibialis anterior.
5. Arthroscopy
To control the articular reduction insert an arthroscope through a medial portal. You cannot make an adequate arthrotomy laterally through the small lateral incision of a minimally invasive approach.
6. Wound closure
To avoid a compartment syndrome do not close the fascia. Close the soft tissues in a routine manner.
