Approach to Medial side of Ankle

Position

  • supine
  • tournique
  • prep & drape

Landmarks

  • medial malleolus

Incision

  • 10 cm curved longitudinal incision centred over the tip of the medial malleolus

Internervous Plane

  • None
    • Dissection straight down to bone

Superficial Dissection

  • Mobilize the skin flaps
    • Taking care not to damage the
      • Long saphenous vein
      • Saphenous nerve

Deep Dissection

  • Osteotomy
    • Identify the point at which the MM joins the shaft of tibia
    • Small longitudinal incision in anterior part of joint capsule
    • Divide the flexor retinculum
    • Identify the tendon of tibialis posterior & retract it posterior to expose the posterior surface of malleolus
    • Score longitudinally to ensure correct alignment of malleolous during closure
      • Pre-Drill & tap
    • Osteotome & oscillating saw
      • Cut through medial malleolus obliquely from top to bottom
      • Checking the position via the anterior arthotomy
  • Retract medial malleolus with attached deltoid ligament downwards
  • Forcibly evert the foot exposing the dome of talus & articulating joint surface of tibia

Dangers

  • Nerves
    • Saphenous nerve
  • Vessels
  • Tendon of tibiallis posterior