Posterolateral Approach to Tibia

Posterolateral approach to the proximal tibia in the lateral decubitus position, with a straight incision along the posterior edge of the fi
Posterolateral approach to the proximal tibia in the lateral decubitus position, with a straight incision along the posterior edge of the fibular head and the common peroneal nerve dissected and protected. Image from Yang S, Lian Y, Yang L, Ma S, Ding C, Huang F, Liu Y, Li H, Mutan Z, Zhong H, Chen H. Fibular head osteotomy, A new technique for better exposure of postero-lateral tibial plateau fracture. J Orthop Traumatol. 2025, 26(1), 19. CC BY 4.0.
Posterolateral Approach to Tibia, muscles of the back of the leg, gray’s anatomy plate 438
Muscles of the back of the leg, Gray’s Anatomy plate 438. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Indications

  • middle 2/3 of tibia when skin is badly affected & anterior app cannot be used

Principles

Position

  • Lateral
  • Protect bony surfaces

Landmarks

  • Lateral border of gastrocnemius

Incision

  • Straight longitudinal incision over lateral border of gastrocnemius muscle

Internervous Plane

Superficial Dissection

  • Reflect skin flaps
  • Taking care not to damage
    • Short saphenous vein
  • Incise fascia
  • Develop the plane between:
    • lateral head of gastrocnemius & soleus posteriorly
    • peroneal muscles anteriorly
  • Encountered
    • Muscular branches of peroneal artery lie with peroneus brevis in proximal part & may be ligated

Deep Dissection

  • Reflect FHL off the posterior aspect of fibula & retract it posteriorly
  • Continue dissection medially across the interosseous membrane detaching fibres of tibialis posterior
  • This leads to lateral border of tibia

Dangers

  • Nerves
  • Vessels
    • Short saphenous vein
    • Branches of peroneal artery
    • Posterior tibial artery

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.