Postmedial approach to ankle

Question 1

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What is the internervous plane for the postmedial approach to the ankle?

Answer 1

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Between FELXOR HALLUCIS LONGS - TIBIAL N

PERONEAL TENDONS- SUPERFICIAL PERONEAL N

Question 2

What is the set up of the patient for this approach?

Answer 2

Prone

sand bag ipsilateral hip

tourniquet

Anaesthesia- general va spinal

Question 3

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Where is the incision made?

Answer 3

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POST BORDER OF FIBULA

need to go to tip of fibula

Question 4

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Describe the superifical dissection?

Answer 4

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Dissect down to FIBULAR, POSTERIOR AND LATERAL

NB- PROX- SUPERIFICIAL PERONEAL N

Question 5

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Describe the deep dissection?

Answer 5

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To access FIBULAR= Retract the PERONEUS BREVIS AND LONGUS POSTERIORLY

To access POST malleolus- anterior retraction of peronesu brevis an longus. Identify division between FHL and peroneal tendons- lift areolar tissue between them.

lift FHL just off post tibia

Retract FHL MEDIALLY

NB- DON’T RELEASE POSTINF TALOFIB LIG–> SYNDESMOTIC INSTABILITY & REVITIALISE THE POST MALLEOLUS

Question 6

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What are the structures at risk?

Answer 6

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Superificial peroneal n- superificial dissection proximally

Posterior Tibial vessels- behind FHL

Sural nerve- distally

TIbial nerve- behind FHL