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- Allows inspection of the anteromedial ankle joint and the anteromedial part of the dome of the talus
- Used mainly for ORIF of the medial malleolus
- The patient is placed supine on the operating table
- Identify the anterior and the posterior borders of the medial malleolus
- A 10-cm longitudinal curved incision, with its midpoint just anterior to the tip of the medial malleolus
- Begin proximally 5 cm above the malleolus and over the middle of the subcutaneous surface of the tibia, crossing the anterior third of the medial malleolus
- The incision is curved forward to end 5 cm anterior and distal to the malleolus
- Widen the skin flaps
- Identify the long saphenous vein and the accompanying saphenous nerve, which lie just anterior to the medial malleolus
- Incise the remaining coverings of the medial malleolus longitudinally to expose the fracture site
- Make a small incision in the anterior capsule of the ankle joint to see the articulating surface
- Split the superficial fibers of the deltoid ligament, which run anteriorly and distally downward from the medial malleolus, so that wires or screws will be anchored solidly on bone
- Preserve the saphenous nerve by preserving the long saphenous vein
- The long saphenous vein is at risk when the anterior skin flaps are mobilized
Proximal
- Incision can be extended along the subcutaneous surface of the tibia
Distal
- Incision can be extended to expose the deltoid ligaments and the talocalcaneonavicular joint
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