Anterolateral Approach to Ankle Joint

  • The anterolateral approach to ankle joint is used to:

    1. Open reduction and internal fixation of pilon fractures.
    2. Open bone biopsy.
    3. Access to the anterior ankle joint for debridement.

  • Place the patient supine on operating table.
  • Place a bump under ipsilateral hip.

  • Proximally, the incision centered between tibia and fibula bones.
  • Distal extension across the ankle, the incision centered on 4th ray of the foot.

  • The internervous plane for the anterolateral approach to ankle joint lies between:
    • Peroneus tertius muscle: which is innervated by the deep peroneal nerve.
    • peroneus brevis muscle: which is innervated by the the superficial peroneal nerve.

  • Full thickness flaps utilized.
  • Care must be taken to protect superficial peroneal nerve:
    • The superficial peroneal nerve is located in the subcutaneous tissue, immediately under the skin.

  • Fascia incised proximally and extensor retinaculum incised over ankle.
  • Anterior compartment tendons elevated and retracted medially.
  • Minimal arthrotomy performed:
    • large arthrotomies lead to devascularization of the anterior distal tibia and should be avoided.

  • Proximal extension of the anterolateral approach to ankle joint:
    • Indications:
      • It’s indicated for proximal plate placement.
    • Dissection is limited proximally by anterior compartment muscle attachments to anterior fibula.
  • Distal extension of the anterolateral approach to ankle joint:
    • Indications:
      • To access talar fractures or talon-avicular injuries.
      • To allow placement of pins for distraction.
    • Dissection:
      • Incision can be extended to talonavicular joint if needed.
      • Extensor digitorum brevis must be elevated.

  • The structures at risk during anterolateral approach to ankle joint include:
    1. Superficial peroneal nerve.
    2. Deep peroneal nerve.
    3. Anterior tibial artery.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
anterolateral approach to ankle anterolateral approach to ankle anterolateral approach to ankle anterolateral approach to ankle anterolateral approach to ankle anterolateral approach to ankle anterolateral approach to ankle
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