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Introduction
  • Provides expsore to
    • lateral malleolus
    • posterior malleolus (requires a fracture or osteotomy in the fibula)
  • Indications
    • posterior malleolus fracture
    • posterior pilon fx
    • osteochondritis dissecans involving lateral dome of talus
    • osteochondromatosis of ankle
 
Approach
  • Position
    • supine with bump under buttock
    • exsanguinate leg
  • Incision
    • begin incision 12 cm proximal to tip of lateral malleolus
    • extend distally along posterior margin of fibula
    • curve anterior following course of peroneal tendons
    • end 2cm below and 2 cm anterior to tip of lateral malleolus
  • Superficial dissection
    • subperiostally expose the fibula
    • incise sheaths of peroneal tendons and displace tendons anteriorly
  • Deep dissection
    • if fibula is not fractured perform osteotomy 10 cm proximal to tip
    • divide interosseous membrane, and anterior and posterior tibiofibular ligaments
      • careful to preserve calcaneofibular and talofibular ligaments
    • rotate distal fibula to expose lateral and posterior aspects of the distal tibia
      • if performing in children be careful not to damage the distal fibular physis
    • Repair fibula with syndosmosis screw from proximal part of the lateral malleolus through the tibiofibular syndesmosis
      • overdrill fibula to close down syndesmosis
 

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