Anterolateral Approach to Ankle Joint indications:
- The anterolateral approach to ankle joint is used to:
- Open reduction and internal fixation of pilon fractures.
- Open bone biopsy.
- Access to the anterior ankle joint for debridement.
Position of the Patient
- Place the patient supine on operating table.
- Place a bump under ipsilateral hip.
Landmarks and Incision
- Proximally, the incision centered between tibia and fibula bones.
- Distal extension across the ankle, the incision centered on 4th ray of the foot.
- The internervous plane for the anterolateral approach to ankle joint lies between:
- Peroneus tertius muscle: which is innervated by the deep peroneal nerve.
- peroneus brevis muscle: which is innervated by the the superficial peroneal nerve.
- Full thickness flaps utilized.
- Care must be taken to protect superficial peroneal nerve:
- The superficial peroneal nerve is located in the subcutaneous tissue, immediately under the skin.
- Fascia incised proximally and extensor retinaculum incised over ankle.
- Anterior compartment tendons elevated and retracted medially.
- Minimal arthrotomy performed:
- large arthrotomies lead to devascularization of the anterior distal tibia and should be avoided.
- Proximal extension of the anterolateral approach to ankle joint:
- It’s indicated for proximal plate placement.
- Dissection is limited proximally by anterior compartment muscle attachments to anterior fibula.
- Distal extension of the anterolateral approach to ankle joint:
- To access talar fractures or talon-avicular injuries.
- To allow placement of pins for distraction.
- Incision can be extended to talonavicular joint if needed.
- Extensor digitorum brevis must be elevated.
- The structures at risk during anterolateral approach to ankle joint include:
- Superficial peroneal nerve.
- Deep peroneal nerve.
- Anterior tibial artery.
- Surgical Exposures in Orthopaedics book – 4th Edition
- Campbel’s Operative Orthopaedics book 12th
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