Access Keys:
Skip to content (Access Key - 0)

Lateral approach to lateral malleolus

Introduction

  • Allows access to the posterolateral aspect of the tibia

Indications

  • ORIF of lateral malleolar fractures

Position of patient

  • Position the patient supine on the operating table, with a sandbag under the buttock of the affected limb

Landmarks and incision

Landmark
  • Identify the subcutaneous surface of the fibula and the lateral malleolus
Incision
  • 10- to 15-cm longitudinal incision along the posterior margin of the fibula to its distal end, where the center of the incision is at the level of the fracture

Internervous plane

  • No internervous plane

Superficial dissection

  • Elevate the skin flaps, taking care not to damage them
  • Be aware that the short saphenous vein and sural nerve lie posterior to the lateral malleolus

Deep dissection

  • Incise the periosteum of the subcutaneous surface of the fibula longitudinally; strip off only as much periosteum as is necessary for accurate reduction
  • All dissection should be strictly subperiosteal to avoid injuring the terminal branches of the peroneal artery

Dangers

Nerves
  • Sural nerve is vulnerable when skin flaps are mobilized
  • Cutting sural nerve may lead to formation of a painful neuroma and numbness along the lateral skin of the foot
Vessels
  • Terminal branches of the peroneal artery lie immediately deep to the medial surface of the distal fibula
  • They can be damaged if dissection does not remain subperiosteal

How to enlarge the approach

Proximal
  • Incision is extended along the posterior border of the fibula, incising the deep fascia in line with the skin incision
  • A new plane between the peroneal muscles (superficial peroneal nerve) and the flexor muscles (tibial nerve)
Distal
  • Incision is curved down the lateral side of the foot
  • Identify the peroneal tendons, the peroneal retinacula incise
  • Detach the fat pad in the sinus tarsi and the origin of the extensor digitorum brevis muscle, exposing the calcaneocuboid joint on the lateral side of the tarsus

Figures

Peer Review

OrthopaedicsOne Peer Review Workflow is an innovative platform that allows the process of peer review to occur right within an OrthopaedicsOne article in an open, transparent and flexible manner. Learn more

Instructions for Authors

Read our Instructions for Authors to learn about contributing or editing articles on OrthopaedicsOne.

Content Partner

Learn about becoming an OrthopaedicsOne Content Partner.

Academic Resources

Resources on Lateral approach to lateral malleolus from Pubget.

Error rendering macro 'rss' : The RSS macro is retrieving an HTML page.
Orthopaedic Web Links

Internet resources validated by OrthopaedicWebLinks.com

Related Content

Resources on Lateral approach to lateral malleolus and related topics in OrthopaedicsOne spaces.

Page: Lateral approach to lateral malleolus (OrthopaedicsOne Articles)
Page: Posteromedial approach to medial malleolus (OrthopaedicsOne Articles)
Page: Anteromedial approach to medial malleolus (OrthopaedicsOne Articles)
Page: Surgical approaches in a nutshell (OrthopaedicsOne Articles)
Page: Retroperitoneal approach to the lumbar spine (OrthopaedicsOne Articles)
Page: Posterior approach to the lumbar spine (OrthopaedicsOne Articles)
Page: Posterior approach to the cervical spine (OrthopaedicsOne Articles)
Page: University of Iowa Foot and Ankle Fellowship (OrthopaedicsOne Fellowships)
Page: Fixing the Difficult Ankle Fracture - Tips and Tricks (OrthopaedicsOne Articles)
Page: Ankle Fracture Complications - Salvaging a Failed ORIF (OrthopaedicsOne Articles)
Showing first 10 of 187 results