Proximal Tibia Bone Graft

Indications

• Fusions and complex fractures in the foot and ankle often require cancellous bone graft.

• Ample bone (≤30 cc) is available from the proximal tibia.

• Bone harvest from the proximal tibial is less painful then from the iliac crest.

• The tibial site can easily be draped into the operative field.

Surgical Anatomy

• The tibial tubercle is a large, oblong elevation where the anterior surfaces of the condyles of the tibia meet and where the patella tendon attaches ( Fig. 77.1 ).

  

• From medial to the tibial tubercle, the proximal tibia is subcutaneous.

• The Gerdy tubercle is on the lateral aspect of the tibial tubercle, where the distal bands of the iliotibial band insert.

• The anterior crest of the tibia starts at the tibial tubercle and ends at the anterior margin of the medial malleolus.

• The anterior crest is sinuous and prominent in the proximal two thirds of the tibia, whereas it is rounded in the distal third.

• The anterior crest provides attachment for the deep fascia.

Medial Approach

Glenn B. Pfeffer