Introduction
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- Indications
- ORIF of medial malleolus fxs
- ORIF of pilon fxs
- Deltoid ligament repair
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| Planes |
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| Preparation |
- Anesthesia
- Preparation
- c-arm, mini vs. full-size to confirm fracture reduction
- Position
- supine
- 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
- Tourniquet
- optional - can be used on the thigh or leg
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| Approach |
- Incision
- Make 10cm 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 5cm distal and 5cm anterior to tip of medial malleolus
- Superficial dissection
- mobilize skin flaps
- identify and protect long saphenous vein just anterior just anterior to medial malleolus
- identify and protect long saphenous nerve, if possible, next to vein
- clear remaining tissues down to periosteum
- Deep dissection
- 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
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| Dangers |
- 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
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