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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
Q

superficial dissectionfor posterolateral approach to the ankle

A

short saphenous vein and sural nerve should be anterior to incision

incised deep fascia

ID peroneal tendons

develop plane between peroneals and FHL

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26
Q
A

fascia covering peroneal compartment

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27
Q
A

FHL

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28
Q
A

FHL

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29
Q
A

PITFL

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30
Q
A

transverse tibiofibular ligament

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31
Q
A

posterior talofibular ligament

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32
Q

deep dissection for posterolateral approach to ankle

A

incised lateral fibres of FHL from fibula and retract medially

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33
Q

dangers for posterolateral approach to ankle

A

short saphenous vein

sural nerve

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34
Q

position for the lateral approach to the lateral malleolus

A

supine

sandbag under buttock

tilt table away

exsanguinate

tourniquet

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35
Q

incision for the lateral approach to the lateral malleolus

A

10-15 cm longitudinal incision along posterior margin of fibula to 2 cm past its distal tip (centre at the level of the fracture

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36
Q

internervous plane for the lateral approach to the lateral malleolus

A

none really - unless you go much more proximal then it is between tertius and brevis

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37
Q

superficial dissection for the lateral approach to the lateral malleolus

A

avoid short saphenous vein and sural nerve (just posterior to lateral malleolus)

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38
Q

deep dissection for the lateral approach to the lateral malleolus

A

strip periosteally to retain blood supply of terminal branches of peroneal artery

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39
Q

dangers for the lateral approach to the lateral malleolus

A

sural nerve

terminal branches of peroneal artery lying on the medial surface of the distal fibula

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40
Q

position for anterolateral approach to ankle and hindfoot

A

supine

sandbag under operative leg buttock

exsanguinate

tourniquet

41
Q

incision for anterolateral approach to ankle and hindfoot

A

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
Q
A

superficial peroneal nerve

43
Q
A

extensor digitorum longus

44
Q
A

tendon of peroneus tertius

45
Q
A

sinus tarsi fat pad

46
Q
A

AITFL

47
Q
A

extensor retinaculum

48
Q

internervous plane for anterolateral approach the ankle hindfoot

A

between peroneals and extensors

49
Q

superficial dissection for anterolateral approach the ankle hindfoot

A

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
Q
A

AITFL

51
Q
A

ATFL

52
Q
A

EDB

53
Q

deep dissection for anterolateral approach to the ankle and hindfoot

A

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
Q
A

calcaneocuboid joint

55
Q
A

talonavicular joint

56
Q

dangers for anterolateral approach to the ankle and hindfoot

A

deep peroneal nerve

anterior tibial artery

57
Q

position for lateral approach to hindfoot

A

supine

sandbad

table tilt

exsanguinate

tourniquet

58
Q

incision for lateral approach to hindfoot

A

curved incision starting just distal and posterior to the tip of the lateral malleolus curving medially to end over the talcalcaneonavicular joint

59
Q

internervous plane for lateral approach to hindfoot

A

peroneus tertius and peroneal tendons

60
Q

superficial dissection for lateral approach to hindfoot

A

do not mobilize widely

ligate any veins

open deep fascia

retract tendons medially

61
Q

deep dissection for lateral approach to hindfoot

A

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
Q

dangers for lateral approach to hindfoot

A

exposures here are notorious for skin necrosis

63
Q
A

bifurcate ligament

64
Q

position for lateral approach to posterior talocalcaneal joint

A

supine

sandbag

tilt table

exsanguinate

tourniquet

65
Q

incision for lateral approach to the posterior talocalcaneal joint

A

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
Q

internervous plane for lateral approach to the posterior talocalcaneal joint

A

none

67
Q

superficial dissection for lateral approach to the posterior talocalcaneal joint

A

ID short saphenous vein and sural nerve

incise fascia

uncover peroneal tendons

incise peroneal fascia

retract tendons anteriorly

incise joint capsule

68
Q

deep dissection for lateral approach to the posterior talocalcaneal joint

A

ID calcaneofubular ligament

often need subperiosteal dissection from calcaneus to find the joint

69
Q

dangers for lateral approach to the posterior talocalcaneal joint

A

sural nerve

70
Q

position for lateral approach to calcaneus

A

lateral

operative leg posterior

exsanguinate

tourniquet

71
Q

incision for lateral approach to calcaneus

A

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
Q

internervous plane for lateral approach to calcaneus

A

none - direct to subcutaneous bone

73
Q

superficial dissection for lateral approach to calcaneus

A

dissect straight down to the lateral surface of the calcaneus

74
Q

deep dissection for lateral approach to calcaneus

A

incise periosteum on lateral wall of calcaneus and develop a full-thickness flap

divide calcaneofibular ligament to expose subtalar joint

75
Q

dangers for lateral approach to calcaneus

A

sural nerve

soft tissue necrosis a risk

76
Q

position for dorsal approach to mid-foot

A

supine

sandbag

exsanguinate

tourniquet

77
Q

incision for dorsal approach to mid-foot

A

longitudinal incision directly over the from the first metatarsal-cuneiform joint to navicular tubercle to 1 cm distal to medial malleolus

78
Q

internervous plane for dorsal approach to mid-foot

A

none - longitudinal incisions tend to spare cutaneous nerves, however, some may be sacrificed

79
Q

dissection for dorsal approach to mid-foot

A

skin

avoid cutaneous nerves

aim for thick skin flaps

minimize retraction

avoid damaging insertions of inverters and everters

80
Q

position for dorsomedial approach to MTP joint of great toe

A

supine

exsanguinate

tourniquet

81
Q

incision for dorsomedial approach to MTP joint of great toe

A

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
Q

internervous plane for dorsomedial approach to MTP joint of great toe

A

none

2 tendons (EHL and AbH)

83
Q
A

deep peroneal nerve

84
Q
A

saphenous nerve

85
Q
A

EHL

86
Q

superficial dissection for dorsomedial approach to MTP joint

A

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
Q

deep dissection for dorsomedial approach to MTP joint

A

incise periosteum

strip coverings of bones

take care not to damage FHL tendon

88
Q

danger for dorsomedial approach to MTP joint

A

tendon of EHL

tendon of FHL

89
Q

Position for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

supine

bolster under thigh on operative side

flex knee

90
Q

incision for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

2-3 cm longitudinal incision on dorsolateral aspect of affected MTP joint just lateral to the long extensor tendon

91
Q

intervervous plane for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

none

avoid the dorsal digital nerves

92
Q

superficial dissection for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

incise fascia medial to extensor tendon and retract the tendon laterally

93
Q

deep dissection for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

incise dorsal capsule of the MTP joint longitudinally to enter the joint

94
Q

danger for dorsal approach to the metatarsophalangeal joints (other than 1st)

A

long extensor tendon

plantar nerves and vessels lie deep to transverse metatarsal ligament between the metatarsal heads

95
Q

position for approach to the dorsal web spaces

A

supine

exsanguinate

tourniquet

sandbag under thigh

flex knee

96
Q

incision for approach to the dorsal web spaces

A

dorsal longitudinal incision over centre of the webspace 2-3 cm from distal web space

97
Q

internervous plane for approach to the dorsal web spaces

A

none

98
Q

superficial dissection for approach to the dorsal web spaces

A

incise deep transverse metatarsal ligament in line with skin

expose neurovascular bundle

view neuroma

99
Q

danger for approach to the dorsal web spaces

A

dorsal cutaneous nerve

take care to protect plantar neurovascular bundle

Orthopedic Surgery Ultimate (88 decks)

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