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Orthopedic Surgery Ultimate > Ankle/Foot Approaches > Flashcards

Ankle/Foot Approaches Flashcards

1
Q

position for anterior approach to ankle

A

supine

exsanguinate

tourniquet

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2
Q

incision for anterior approach to ankle

A

15 cm longitudinal incision over anterior aspect of the ankle joint from 10 cm proximal to 5 cm distal

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3
Q

internervous plane for anterior approach to ankle

A

use the intermuscular plane between EHL and EDL

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4
Q

superficial dissection for anterior approach to ankle

A

incise deep fascia

cut extensor retinaculum

retract EHL medially with NV bundle

retract EDL laterally

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5
Q
A

extensor hallucis longus

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6
Q
A

extensor digitorum longus

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7
Q
A

superficial peroneal nerve

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8
Q
A

deep peroneal nerve and anterior tibial artery

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9
Q

deep dissection for anterior approach to the ankle

A

incised soft tissue

incise ankle joint capsule

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10
Q

dangers for anterior approach to ankle

A

cutaneous branches of superficial peroneal nerve

deep peroneal nerve

anterior tibial artery

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11
Q

position for approaches to medial malleolus

A

supine

exsanguinate

tourniquet

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12
Q

incisions for approaches to medial malleolus

A

anterior - 10 cm longitudinal curved with midpoint just anterior to the tip of the medial malleolus

posterior - 10 cm incision starting 5 cm above the ankle on the posterior border of the tibia curving forward behind the medial malleolus

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13
Q

internervous plane for approaches to medial malleolus

A

none. subcutaneous bone

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14
Q

superficial dissection for approaches to medial malleolus

A

ID long saphenous vein and nerve

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15
Q

anterior - deep dissection for approaches to medial malleolus

posterior - incise fascia over tibialis posterior

retract tib post anterior, the rest posterior

A

incise retinaculum

split deltoid ligament

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16
Q

dangers for approaches to medial malleolus

A

anterior - saphenous nerve, long saphenous vein

posterior - tom, dick and very nervous harry

both - vascularity of bone fragments

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17
Q

position for posteromedial approach to ankle

A

supine with hip and knee flexed and leg in external rotation

or

lateral with operative side down and other knee flexed and draped over

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18
Q

incision for posteromedial approach to ankle

A

8-10 cm longitudinal incision midway between medial malleolus and achilles

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19
Q

superficial dissection for posteromedial approach to ankle

A

incise fascia away from the posterior bundle of structures

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20
Q

deep dissection for posteromedial approach to ankle

A

3 options:

1) posterior to FHL
2) between FHL and the NV bundle
3) direct onto the Tom, Dick and Harry (only for lengthening

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21
Q

dangers for posteromedial approach to ankle

A

posterior tibial artery

tibial nerve

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22
Q

position for posterolateral approach to the ankle

A

prone

abdomen free

bump under operative leg

exsanguinate

tourniquet

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23
Q

incision for posterolateral approach to the ankle

A

10 cm longitudinal halfway between posterior border of lateral malleolus and lateral border of achilles

begin at tip of fibula and extend proximally

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24
Q

internervous plane for posterolateral approach to the ankle

A

peroneus brevis and FHL

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25
superficial dissectionfor posterolateral approach to the ankle
short saphenous vein and sural nerve should be anterior to incision incised deep fascia ID peroneal tendons develop plane between peroneals and FHL
26
fascia covering peroneal compartment
27
FHL
28
FHL
29
PITFL
30
transverse tibiofibular ligament
31
posterior talofibular ligament
32
deep dissection for posterolateral approach to ankle
incised lateral fibres of FHL from fibula and retract medially
33
dangers for posterolateral approach to ankle
short saphenous vein sural nerve
34
position for the lateral approach to the lateral malleolus
supine sandbag under buttock tilt table away exsanguinate tourniquet
35
incision for the lateral approach to the lateral malleolus
10-15 cm longitudinal incision along posterior margin of fibula to 2 cm past its distal tip (centre at the level of the fracture
36
internervous plane for the lateral approach to the lateral malleolus
none really - unless you go much more proximal then it is between tertius and brevis
37
superficial dissection for the lateral approach to the lateral malleolus
avoid short saphenous vein and sural nerve (just posterior to lateral malleolus)
38
deep dissection for the lateral approach to the lateral malleolus
strip periosteally to retain blood supply of terminal branches of peroneal artery
39
dangers for the lateral approach to the lateral malleolus
sural nerve terminal branches of peroneal artery lying on the medial surface of the distal fibula
40
position for anterolateral approach to ankle and hindfoot
supine sandbag under operative leg buttock exsanguinate tourniquet
41
incision for anterolateral approach to ankle and hindfoot
15 cm slightly curved incision on anterolateral aspect of the ankle beginning 5 cm proximal to ankle joint and 2 cm anterior to the anterior border of fibula, end 2 cm medial to 5th metatarsal (over the 4th)
42
superficial peroneal nerve
43
extensor digitorum longus
44
tendon of peroneus tertius
45
sinus tarsi fat pad
46
AITFL
47
extensor retinaculum
48
internervous plane for anterolateral approach the ankle hindfoot
between peroneals and extensors
49
superficial dissection for anterolateral approach the ankle hindfoot
incise fascia incise inferior and superior retinacula ID and preserve dorsal cutaneous branches of superficial peroneal nerve ID peroneus tertius and EDL incise to bone just lateral to these muscles
50
AITFL
51
ATFL
52
EDB
53
deep dissection for anterolateral approach to the ankle and hindfoot
retract extensors medially detach EDB from calcaneus ID dorsal capsules of the calcaneocuboid and talonavicular joints (midtarsal joint) ID fat in the sinus tarsi, clear it to expose the talocalcaneal joint
54
calcaneocuboid joint
55
talonavicular joint
56
dangers for anterolateral approach to the ankle and hindfoot
deep peroneal nerve anterior tibial artery
57
position for lateral approach to hindfoot
supine sandbad table tilt exsanguinate tourniquet
58
incision for lateral approach to hindfoot
curved incision starting just distal and posterior to the tip of the lateral malleolus curving medially to end over the talcalcaneonavicular joint
59
internervous plane for lateral approach to hindfoot
peroneus tertius and peroneal tendons
60
superficial dissection for lateral approach to hindfoot
do not mobilize widely ligate any veins open deep fascia retract tendons medially
61
deep dissection for lateral approach to hindfoot
detach fat pad partially detach origin of EDB reflect distally access which joint you are interested in access the posterior talocalcaneal joint by retracting the peroneals anteriorly
62
dangers for lateral approach to hindfoot
exposures here are notorious for skin necrosis
63
bifurcate ligament
64
position for lateral approach to posterior talocalcaneal joint
supine sandbag tilt table exsanguinate tourniquet
65
incision for lateral approach to the posterior talocalcaneal joint
10-13 cm on lateral aspect of ankle beginning 4 cm above tip of lateral malleolus on posterior border of fibula, then curve forward just under the peroneal tubercle on the lateral calcaneous
66
internervous plane for lateral approach to the posterior talocalcaneal joint
none
67
superficial dissection for lateral approach to the posterior talocalcaneal joint
ID short saphenous vein and sural nerve incise fascia uncover peroneal tendons incise peroneal fascia retract tendons anteriorly incise joint capsule
68
deep dissection for lateral approach to the posterior talocalcaneal joint
ID calcaneofubular ligament often need subperiosteal dissection from calcaneus to find the joint
69
dangers for lateral approach to the posterior talocalcaneal joint
sural nerve
70
position for lateral approach to calcaneus
lateral operative leg posterior exsanguinate tourniquet
71
incision for lateral approach to calcaneus
2 limbs: one from base of 5th metatarsal extending posteriorly along skin change line, second 6 to 8 cm above the heel skin halfway between the posterior aspect of the fibula and the lateral aspect of the Achilles. they meet in an L shape
72
internervous plane for lateral approach to calcaneus
none - direct to subcutaneous bone
73
superficial dissection for lateral approach to calcaneus
dissect straight down to the lateral surface of the calcaneus
74
deep dissection for lateral approach to calcaneus
incise periosteum on lateral wall of calcaneus and develop a full-thickness flap divide calcaneofibular ligament to expose subtalar joint
75
dangers for lateral approach to calcaneus
sural nerve soft tissue necrosis a risk
76
position for dorsal approach to mid-foot
supine sandbag exsanguinate tourniquet
77
incision for dorsal approach to mid-foot
longitudinal incision directly over the from the first metatarsal-cuneiform joint to navicular tubercle to 1 cm distal to medial malleolus
78
internervous plane for dorsal approach to mid-foot
none - longitudinal incisions tend to spare cutaneous nerves, however, some may be sacrificed
79
dissection for dorsal approach to mid-foot
skin avoid cutaneous nerves aim for thick skin flaps minimize retraction avoid damaging insertions of inverters and everters
80
position for dorsomedial approach to MTP joint of great toe
supine exsanguinate tourniquet
81
incision for dorsomedial approach to MTP joint of great toe
begin just proximal to interphalangeal joint on dorsomedial aspect of great toe curve over dorsal aspect of MTP joint remain medial to tendon of EHL then along medial shaft of 1st metatarsal
82
internervous plane for dorsomedial approach to MTP joint of great toe
none 2 tendons (EHL and AbH)
83
deep peroneal nerve
84
saphenous nerve
85
EHL
86
superficial dissection for dorsomedial approach to MTP joint
incise fascia dorsal digital branch of medial cutaneous nerve protected laterally U-shaped incision in joint capsule leaving it attached to proximal edge of proximal phalanx
87
deep dissection for dorsomedial approach to MTP joint
incise periosteum strip coverings of bones take care not to damage FHL tendon
88
danger for dorsomedial approach to MTP joint
tendon of EHL tendon of FHL
89
Position for dorsal approach to the metatarsophalangeal joints (other than 1st)
supine bolster under thigh on operative side flex knee
90
incision for dorsal approach to the metatarsophalangeal joints (other than 1st)
2-3 cm longitudinal incision on dorsolateral aspect of affected MTP joint just lateral to the long extensor tendon
91
intervervous plane for dorsal approach to the metatarsophalangeal joints (other than 1st)
none avoid the dorsal digital nerves
92
superficial dissection for dorsal approach to the metatarsophalangeal joints (other than 1st)
incise fascia medial to extensor tendon and retract the tendon laterally
93
deep dissection for dorsal approach to the metatarsophalangeal joints (other than 1st)
incise dorsal capsule of the MTP joint longitudinally to enter the joint
94
danger for dorsal approach to the metatarsophalangeal joints (other than 1st)
long extensor tendon plantar nerves and vessels lie deep to transverse metatarsal ligament between the metatarsal heads
95
position for approach to the dorsal web spaces
supine exsanguinate tourniquet sandbag under thigh flex knee
96
incision for approach to the dorsal web spaces
dorsal longitudinal incision over centre of the webspace 2-3 cm from distal web space
97
internervous plane for approach to the dorsal web spaces
none
98
superficial dissection for approach to the dorsal web spaces
incise deep transverse metatarsal ligament in line with skin expose neurovascular bundle view neuroma
99
danger for approach to the dorsal web spaces
dorsal cutaneous nerve take care to protect plantar neurovascular bundle

Orthopedic Surgery Ultimate (88 decks)

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