Posterolateral Approach to the Ankle

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- Discussion:
    - allows access for ORIF of fractures of ankle w/ frx of posterior tibial lip;
    - allows access for removal of osteochondritis dissecans fragments from
            lateral part of dome of talus and for osteochondromatosis of ankle;
- Incision:
    - begin incision about 12 cm proximal to tip of lateral malleolus &
          extend it distally along posterior margin of fibula to tip of malleolus;
    - curve incision anteriorly for 2.5-4 cm in line of peroneal tendons;
    - expose fibula including lateral malleolus subperiosteally;
    - incise peroneal tendon sheaths & retract them anteriorly;
    - fibular osteotomy
          - if fibula is intact, transect it about 10 cm proximal to tip of lateral malleolus;
          - free distal fragment by dividing the interosseous membrane and
                anterior and posterior malleolar ligaments;
          - carefully preserve calcaneofibular and talofibular ligaments to serve
                as a hinge and to maintain the integrity of ankle after operation;
          - turn the fibula laterally on this hinge, and expose lateral & posterior
                aspects of distal tibia & lateral aspect of ankle joint;