anterior approach to ankle

Question 1

What is the indications for this approach?

Answer 1

Pilon ankle fracture
Ankle fusion
I&D of ankle

Question 2

What is the intermuscular plane?

Answer 2

Between
EXT HALLUCIS LONGUS
EXT DIGITORIUM LONGUS
Both supplied by DEEP PERONEAL N

Question 3

What would the pt set up be?

Answer 3

Spinal/GA

Partial exsangination of leg - better visualisation of neurovascular bundle

Question 4

Describe the incision ?

Answer 4

Make 15cm incision Midpoint of the ankle between malleoli
start proixmal
Stay superificial to avoid damage to branches of SUPERFIICAL PERONEAL N

Question 5

Describe the supericial dissection?

Answer 5

Incise FASCIA in line with skin incision
Incise EXTENSOR RETINACULUM
FInd division betwenn EHL and EDL above ankle
Identify tje NV bundle- deep peromeal nerve and ant tibial artery
retract EHL and NV bundle- MEDIALLY
Retract EDL LATERALLY

Question 6

Describe the deep dissection?

Answer 6

Incise capsule to enter joint

reveal talus and tibia by superiosteal and capsular release

Question 7

Describe the medial variation in dissection?

Answer 7

INCISE THE SKIN 15CM ANT TO MEDIAL MALL
INCISE DEEP FASCIA MEDIAL TO TIBIALIS ANT TENDON
RETRACT TIBAILIS ANT TENDON LATERALLY TO EXPOSE JOINT

Question 8

What are the dangers with this approach?

Answer 8

CUTANEOUS BRANCHES OF SUPERFICIAL PERONEAL N- greatest danger during skin incision
nV bundle- DEEP PERONEAL N AND ANT TIBIAL ARTERY

Question 9

Where does NV bundle cross?

Answer 9

Behind EHL at ankle joint