ANTEROLATERAL approach to ankle

Question 1

What are the indications for this approach?

Answer 1

Talus dislocations

Exposure of ANKLE joint, TALONAVICULAR, CALCANEOCUBOID and TALOCALCANEAL -ie for TRIPLE ARTHRODESIS, ANKLE FUSION

Question 2

Describe the incision?

Answer 2

15cm incision on anterolat aspect of ankle
Begin 5cm proximal of ankle joint
2cm anterior to ANT BORDER OF FIBULAR
2cm MEDIAL to TIP OF LAT MALL
Continue onto foot end MEDIAL TO 5TH MT BASE

Question 3

What is the internervous plane?

Answer 3

Between
PERONEAL MUSCLES- SUPERIFICAL PERONEAL N and
EXTENSOR MUSCLES - DEEP PERONEAL N

Question 4

Describe the superificial surgical dissection?

Answer 4

INCISE FASCIA in line with skin thru superior and inferior extensor retinaculum
Do not develop skin flaps
Preserve ant branche of SUP.PERONEAL N
Identify PERONEUS TERTIUS & EXT DIG LONGUS
IN upper wound incise down to BONE LATERAL to muscles

Question 5

Describe the deep surgical dissection?

Answer 5

RETRACT PERONEUS TERTIUS & EDL MEDIALLY to expose DISTAL TIBIA, ANT ANKLE JOINT
DISTALLY identify EXT DIG BREVIS muscle at insertion from CALCANEUS
DETACH AND RETRACT EDB DISTALLY & MEDIALLY, LIFTING MUSCLE FASCIA and subcutanous tissue as one flap - need to cauterie lateral tarsal arteries during this
Identify dorsal capsule of CALCANEOCUBOID & TALONAVICULAR joints next to each other
Clear FAT FROM SINUS TARSI- /MOBILISE to expose the TALOCALCANEAL JOINT
OPEN JPINT BY PLANTARFLEXION, INVERSION

Question 6

What are the dangers with this approach?

Answer 6

DEEP PERONEAL N

ANT TIBIAL ARTERY CROSS FRONT OF ANKLE

Question 7

Can the incision be extended?

Answer 7

Yes proximally to explore ant comparmtent of leg, thru skin , fascia
Distally- to expose TMT joint on lat half of foot- continue over 4th MT