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Approach to the Lateral Malleolus

 Approach to the Lateral Malleolus

Approach to the Lateral Malleolus indications include:

The Approach to the Lateral Malleolus is used primarily for open reduction and internal fixation of lateral malleolar fractures.

The other uses of Lateral Malleolus Approach include:

  1. Open reduction and internal fixation of syndesmosis ligaments.
  2. Percutaneous placement of syndesmosis screws.
  3. Access to the posterolateral tibia.
See Also: Ankle Anatomy

Position of the Patient

Place the patient supine on the operating table with a sandbag under the buttock of the affected limb. The sandbag causes the limb to rotate medially, bringing the lateral malleolus forward and making it easier to reach

Approach to the Lateral Malleolus

Landmarks and Incision

Approach to the Lateral Malleolus

Internervous plane

Superficial dissection

Deep dissection

Approach Extension

Proximal Extension:

See Also: Lateral approach to the fibula.

Distal Extension:

The Approach to the Lateral Malleolus may be extended distally to become continuous with:

  1. Ollier’s lateral approach to the tarsus.
  2. Kocher lateral approach to the ankle and tarsus.
  3. Lateral approach to the calcaneus.

Posterior Extension:

Dangers

The structures at risk during the Approach to the Lateral Malleolus include:

  1. Sural nerve: It’s injury may lead to formation of a painful neuroma and numbness along the lateral skin of the foot.
  2. Short Saphenous vein.
  3. Terminal branches of peroneal artery: They lie deep to medial surface of distal fibula. They can be damaged if dissection does not stay subperiosteal, and may form hematoma after removal or tourniquet.
  4. Superficial peroneal nerve: The Superficial peroneal nerve crosses from posterior to anterior over the fibular shaft at the proximal end of the incision.

References


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