A Novel Modification in the Anterolateral Approach to the Proximal Tibia: Technical Note and Clinical Perspective

Background: Exposure of the proximal tibia for fracture fixation and reconstructive procedures is often achieved through the anterolateral approach.It is one of the most commonly used approaches for addressing the proximal tibial fractures, including Schatzker I-VI.The current surgical approach often meets with difficulty in proper closure of the incised iliotibial band and the deep fascia over the fixed lateral plate [proximal tibial lateral locking compression plate (LCP) 3.5/4.5 mm], which sometimes results in wound breakdown with exposed implant or a feeling of implant protuberance to the patient.Methods: We describe a novel modification of the standard anterolateral approach aimed at proper closure of the iliotibial band and the deep fascia over the implant while maintaining the integrity of soft-tissue envelopes.The technical steps, anatomical landmarks, and safety considerations are presented along with our early clinical experience.Results: The application of this modification in a series of proximal tibial fractures demonstrated satisfactory intraoperative exposure, facilitated anatomical reduction, and proper closure of the deep fascia over the implant.Patients were mobilized early with no cases of wound breakdown, no implant protuberance, and no discomfort to the patient.Conclusion: This modified anterolateral approach offers a safe, reproducible method to improve closure of deep fascia over the implant in the proximal tibial fractures.It balances enhanced closure with maintaining the soft-tissue envelopes.