The anterior surface of the tibial shaft is smooth, subcutaneous throughout, and provides origin for tibialis anterior in its upper two-thirds. The tibial crest (anterior border) divides the medial and anterior surfaces. This surface is directly palpable through the skin along the entire length of the lower leg.
The anterior tibial surface is the site of shin splints in the anterior compartment variant, producing periosteal tenderness along the anterolateral tibia rather than the posteromedial border. Tibial shaft plating uses the anteromedial surface for medial plating approaches. The subcutaneous nature of the anterior tibia makes it highly susceptible to open fractures and wound complications after ORIF. Tibialis anterior originates from the lateral aspect of this surface.
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