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Anteromedial approach to medial malleolus

Introduction

  • Allows inspection of the anteromedial ankle joint and the anteromedial part of the dome of the talus

Indications

  • Used mainly for ORIF of the medial malleolus

Position of patient

  • The patient is placed supine on the operating table

Landmarks and incision

Landmark
  • Identify the anterior and the posterior borders of the medial malleolus
Incision
  • 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

Internervous plane

  • No internervous plane.

Superficial dissection

  • Widen the skin flaps
  • Identify the long saphenous vein and the accompanying saphenous nerve, which lie just anterior to the medial malleolus

Deep dissection

  • 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

Dangers

  • Preserve the saphenous nerve by preserving the long saphenous vein
  • The long saphenous vein is at risk when the anterior skin flaps are mobilized

How to enlarge the approach

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

Figures

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