Anterior Approach to the Ankle Joint

Indications

  • arthrodesis
  • septic ankle
  • r/o loose bodies
  • ORIF pilon Fracture

Position

  • supine
  • exsanguinate foot (partially)
  • inflate tourniquet

Landmarks

  • medial malleolus
  • lateral malleolus

Incision

  • Start: 15 cm incision centered over anterior aspect of ankle
  • Start 10 cm proximal to joint
  • End: dorsum of foot
  • Cut only skin
    • Bw anterior neurovascular bundle
    • Superficial peroneal nerves

Internervous Plane

  • None
  • Between EHL & ED
    • Both supplied by Deep peroneal nerve
    • Both receive nerve supply very proximal

Superficial Dissection

  • Incise deep fascia
  • Incise extensor retinaculum
  • Dissect between EHL & ED
  • Identify neurovascular bundle just medial to EHL
    • Anterior tibial artery
    • Deep peroneal nerve
  • Retract EHL & NV bundle medially
  • Retract ED laterally

Deep Dissection

  • Incise ankle joint capsule
  • Perform periosteal stripping if necessary

Dangers

  • Nerves
    • Branches of superficial peroneal nerve
    • Deep peroneal nerve
  • Artery
    • Anterior tibial artery
  • NB
    • Above ankle joint
      • NV bundle lies between EHL & TibAnt
    • At joint
      • EHL tendon crosses NV bundle
  • Proximally
    • Expose structures of anterior compartment
  • Distally
    • Dorsum of Foot