Anterior approach to the ankle

Position

supine
tornique
prep & drape leg free

Landmarks

medial malleolus
lateral malleolus

Incision

15 cm straight longitudinal incision centred midway between the malleoli

Internervous Plane

Extensor hallucis longus
- Deep peroneal nerve
Extensor digitorum longus
- Deep peroneal nerve

Superficial Dissection

taking great care to cut only the skin
- anterior neurovascular bundle
- branches of superficial peroneal nerve
Incise the facia in line with skin incision
Cutting through the extensor retinaculum
Identify & develop the plane with EHL & EDL a few cm above the ankle joint
Identify & protect the NV bundle on the medial side of EHL
- Trace the bundle distally as it crosses over the ankle joint behind the tendon of EHL
Retract EHL medially with the NV bundle
Retract EDL laterally
Alternative
- Plafond fractures
  - Incise deep fascia on medial side of tibialis anterior
  - Exposing tibia & anteromedial ankle joint tendon

Deep Dissection

Exposes the anterior surface of tibia
Longitudinal incision through anterior capsule
- Detaching capsule as necessary with sharp dissection

Dangers

Nerves
- Superficial peroneal nerve
- Deep peroneal nerve
Vessels
- Anterior tibial artery