Medial Approach to the Ankle Joint

Aims

Approach the ankle joint via medial incision

Indications

arthrodesis
excision of osteochondral fragments from medial side of talus
r/o loose bodies

Position

supine
partial exsanguination

Landmarks

medial malleolus

Incision

10 cm longitudinal incision
Centred over tip of medial malleous
Start: medial surface of tibia
End: medial cuneiform

Internervous Plane

None

Superficial Dissection

Mobilize skin flaps
- Beware
  - Long saphenous vein
  - Saphenous nerve

Deep Dissection

Divide flexor retinaculum
- Retact Tib Post posteriorly
Medial Malleolar osteotomy
- Score M.M. longitudinally to ensure correct alignment during closure
- Drill & tap medial malleolus so that it can be reattached
Incise anteromedial ankle joint to help identify anterolateral junction of distal tibia
Oscillating saw
- Cut through MM obliquely from top to bottum
- Retract MM with deltoid ligament inferiorly
Evert foot to expose talar dome

Dangers

Nerves
- Saphenous
Veins
- Long saphenous vein
Tendon
- Tibialis posterior