Anteromedial Approach to Ankle Joint
Anteromedial Approach to Ankle Joint indications:
- The Anteromedial Approach to Ankle Joint is used for the following purposes:
- Open reduction and internal fixation of medial malleolus fractures.
- Open reduction and internal fixation of pilon fractures.
- Deltoid ligament repair.
Position of the Patient
- Supine position.
- Place foot in slight external rotation to allow better visualization of medial malleolus:
- if a bump is utilized, it can be removed to allow extremity to externally rotate
Landmarks and Incision
- Make 10 cm longitudinal, curved incision on medial ankle:
- begin 5cm proximal to medial malleolus over subcutaneous tibia.
- continue incision across anterior third of medial mallelous.
- this can be curved apex anteriorly for improved visualization of the ankle joint.
- finish 5 cm distal and 5cm anterior to tip of medial malleolus.
- There is No internervous plane for the Anteromedial Approach to Ankle Joint.
- Mobilize skin flaps.
- Identify and protect long saphenous vein just anterior to medial malleolus.
- Identify and protect long saphenous nerve, if possible, next to vein.
- Clear remaining tissues down to periosteum.
- Expose fracture site for medial malleolus fracture.
- Make small incision in anterior joint capsule to visualize joint and dome of talus.
- Split fibers of deltoid ligament to allow hardware to seat directly on bone.
- Posterior tibial tendon should be visualized to ensure that it remains intact.
- The structures at risk during the Anteromedial Approach to Ankle Joint include:
- Saphenous nerve:
- prevent injury by protecting and preserving the long saphenous vein.
- often too small for direct visualization.
- damage to nerve may cause.
- formation of painful neuroma.
- numbness over medial foot.
- Long Saphenous vein:
- prevent injury by mobilizing anterior skin flaps with caution.
- preservation is ideal so it can be utilized as a vein graft in future.
- Saphenous nerve:
- Surgical Exposures in Orthopaedics book – 4th Edition
- Campbel’s Operative Orthopaedics book 12th