Ankle & Hindfoot – Anterolateral Approach

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