lateral approach to calcaneum

Question 1

What is the position of the patient?

Answer 1

Supine
sandbag under buttocks- bring lat malleolus forward
Support for pt and angle table 20-30 away
Exsanguate leg

Question 2

Describe your incision?

Answer 2

curved 10-15cm incision
Begin 4cm above tip of lat mall on POST BORDER
Follow border down to tip of LAT MALL where curve incision towards peroneal tubercle tendons, parallel to peroneal tendons

Question 3

What is this internervous plane?

Answer 3

None. ALL supplied by SUPERFICIAL PERONEAL N - by more prox so no risk

Question 4

Describe the superificial dissection?

Answer 4

Mobilise the skin flaps minimally
Care not to damage sural N behind lat mall with short saphenous vein
INCISE FASCIA OVER PERONEI ( BREVIS CLOSEST lat mall and muscular at lat mall cf LONGUS
LONGUS has separate sheath- inferior peroneal reticulum distal to tip.
Continue to incise fascia
Must repair these on closure
Retract Tendons- anteriorly and medially over fibula

Question 5

Describe the deep dissection?

Answer 5

Identify the CALCANEOFIBULAR LIGAMENT
between lat mall and lat surface of calcaneum
INCISE the CALCANEFIBULAR LIG to gain acces to the TALOCALCANEAL CAPSULE.
INCISE the capsule transversely to gain access to the TALOCALCANEAL JOINT

Question 6

What are the dangers with this approach?

Answer 6

Sural Nerve

Question 7

How can the lateral aspect of the calcaneus be exposed with this approach?

Answer 7

By extension
Incise the periosteum over the lat surface and strip it inferiorly by sharp dissection
to see the talus better cut the calcaneofibular ligament and cspsule superiorly
exposure of articular surface with foot inverted. If foreful inversion doesn’t open joint