OrthoNet

Ankle - medial approach

* position - supine with tourniquet

* incision - long. incision centered on tip of medial malleolus, curve forward onto medial side of middle part of foot

* no internervous plane

* dissection
- mobilize skin flaps
- avoid long saphenous vein & saphenous n.
- ID where med. malleolus joins shaft of tibia & make small long. incision in ant. joint capsule
- divide flexor retinaculum & ID TP tendon
- retract TP post.
- expose post. surface of med. malleolus
- score med. malleolus long.
- drill & tap med. malleolus
- using oscillating saw, ostotomize med. malleolus from sup. to inf.
- reflect med. malleolus inf. with deltoid attachment
- evert foot to bring dome of talus into view

* dangers
- saphenous n. & long saphenous vein - run just ant. to med. malleolus
- TP - lies just post. to med. malleolus