Approach to the Lateral Malleolus

Aims

• Exposure of the lateral malleolus

Indications

• Fracture Fixation

Position

• supine
• sandbag under buttock
• exsanguinate
• tourniquet

Landmarks

• subcutaneous surface of fibula
• lateral malleolus

Incision

• 10-15cm incision along posterior margin of fibula

Internervous Plane

• None
• More proximally
  • Peroneus tertius deep peroneal nerve
  • Peroneus brevis superficial peroneal nerve

Superficial Dissection

• Elevate skin flaps
  • Beware
    • Short saphenous vein
    • Sural nerve

Deep Dissection

• Incise periosteum
• Beware
  • Terminal branches of peroneal artery

Dangers

• Sural nerve
• Terminal branches of peroneal artery

Procedure

• Proximal
  • Posterior border of fibula
• Distal
  • Curve incision over lateral side of foot
    • Identify peroneal tendons & incise peroneal retinaculum
    • Detach fat pad from sinus tarsi
    • Detach origin of EDB to expose CC joint