- See:
- Anterolateral Approach
- Kocher approach
- Posterolateral Approach to the Ankle: (Gatellier and Chastang)
- Medial Approach to the Ankle
- Anterior Approach:
- allows acces to medial malleolus & medial articular facet of body of talus
- it is used for ankle fusion, anterior lip fractures of tibia, for placement of percutaneous screws, & for arthrotomy of joint to drain infection or remove loose bodies,
- anterior approach is centered between the malleoli;
- cutaneous branches of the superficial peroneal nerve should be identified and protected;
- extensor retinaculum & location of anterior neurovascular bundle is identified;
- usually the approach is developed thru EHL & EDL tendons;
- retinaculum is split & plane of dissection is either between EDL & EHL tendons w/ medial retraction of EHL & neurovascular bundle;
- alternatively approach is made medial to tibialis anterior tendon w/ lateral retraction of both tibialis anterior tendon and neurovascular bundle;
- neurovascular bundle is retracted laterally with the extensor tendons of toes, and tibialis anterior tendon is retracted medially;
- ankle capsule and the joint are then exposed;
- Lateral Approach to the Ankle;
- used for treatment of lateral collateral ligament injuries, fractures of the fibula ect;
- incision is either anterolateral or posterolateral to subQ lateral border of fibula, and can be curved distally around tip of fibula;
- short saphenous vein and sural nerve lie posterior & superficial peroneal nerve anterior to this incision;
- proximally dissection proceeds between peroneus tertius & peroneus longus and brevis posteriorly;
- posterior tibia can be exposed by dissection behind and around peroneal tendons;
- it is usually not necessary to remove these tendons from their sheath or divide the retinaculuum;
- Posterior Approach to the Ankle:
- allows acces to distal end of tibia, posterior aspect of ankle joint, posterior end of talus, subtalar joint, & posterior part of superior surface of calcaneus;
- position: pt is prone;
- make a 12 cm incision along the posteolateral border of the tendocal-caneus down to the insertion of the tendon on the calcaneus;
- alternatively make incision is made on either side of Achilles tendon;
- retinaculum and tendon sheath are not entered;
- dissect between peroneal muscles & FHL;
- if dissection is kept lateral to FHL tendon, posterior tibial vessels & tibial nerve, will not be damaged, since this tendon protects them;
- expose posterior surface of the tibia and the joint capsule