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Posterolateral Approach to the Tibia

- Anatomy:
    - anterior compartment
    - lateral compartment
    - deep posterior compartment
    - superfical posterior

- Anatomy:
    - position: either prone or on side, with the affected extremity uppermost;
    - incision:
           - incision is made just posterior to the fibula along the lateral border of the gastrocnemius;
           - cutaneous branch of the peroneal nerve must be protected;
    - inter-neural plane:
           - access to deep posterior compartment is between lateral and superficial posterior compartments;
           - develop plane between superficial compartment posteriorly & peroneal muscles anteriorly;
           - detach the distal part of the origin of the soleus from fibula & retract it posteriorly and medially;
           - develop plane between FHL posteriorly & peroneal muscles anteriorly;
    - attachments of the FHL to the posterior surface of the fibula are freed;
    - once the FHL is cleared off of the fibula, take care to avoid the peroneal artery (disssection proceeds between FHL and fibula);
    - direct dissection toward interosseous membrane;
           - detach tibialis posterior from interosseous membrane;
           - posterior tibial artery & tibial nerve lie in protected position behind tibialis posterior & FHL;
    - continue dissection along interosseous membrane to lateral border of tibia;
    - detach subperiosteally muscles that arise from posterior surface of tibia;
    - posterior surface of tibial shaft may be completely exposed, except for the proximal fourth which should remain intact (gives rise to popliteus)

The risk of injury to the peroneal artery in the posterolateral approach to the distal tibia: a cadaver study.