- See:
Anteromedial Approach:
- Discussion:
- may be used for
frx dislocations of talus, traumatic injuries to ankle joint, and
osteochondritis dissecans of the talus;
-
disadvantages: possible to injure the tibial vessels and nerves;
-
incision:
- centered on malleolus & is made longitudinal or curved distally,
depending on the exposure needed;
- shift incision anteriorly for access to joint;
- shift posteriorly to expose the back of the tibia;
- protect
saphenous nerve and saphenous vein which lie superficially just
anterior to the malleolus;
- keep dissection on bone in order to protect
tibialis posterior tendon, which
is easily lacerated during exposure of the posterior aspect of malleolus;
- tibialis posterior,
FDL, neurovascular bundle, &
FHL are elevated as
group and gently retracted medially or posteriorly;
- curve the incision just proximal to the medial malleolus, and divide
malleolus with an osteotome;
- preserve the attachment of the deltoid ligament;
- later replace malleolus and fix it w/ screw;
- to make replacement easier, drill hole for screw before osteotomy;
- posterior malleolus is exposed by reflecting capsule and periosteum
retracting tendons of
tibialis posterior,
FDL &
FHL muscles along
with the neurovascular bundle posteriorly and medially;
