OrthoNet

Ankle & hindfoot - anterolateral approach

* position - supine with sandbag under buttock

* incision
- curved incision on anterolat. aspect of ankle
- start 5 cm prox. to ankle joint & 2 cm ant. to ant. border of fibula
- curve distally crossing ankle joint 2 cm med. to tip of lat. malleolus
- end 2 cm med. to 5th MT base over base of 4th MT

* internervous plane - peroneal muscles (SPN) & extensor muscles (DPN)

* dissection
- incise fascia in line with skin thru sup. & inf. extensor retinacula
- ID & preserve any dorsal branches of SPN
- ID peroneus tertius & EDL
- in upper half of wound, incise down to bone lat. to these muscles
- retract extensors med.
- distally ID EDB at origin from calcaneus & detach
- branches of lat. tarsal art. need to be cauterized
- reflect EDB distally & med.
- ID dorsal capsule of calcaneocuboid & talonavicular joints
- ID fat in sinus tarsi & clear to expose talocalcaneal joint
- incise joint capsules

* dangers
- DPN & ATA - cross front of ankle joint btw EHL & EDL