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Indications
  • Calcaneal fracture
Intermuscular Plane
  • No internervous plane
  • Peroneal longus and brevis both supplied by superficial peroneal nerve
Approach
  • Position
    • place supine on table
    • bump under buttock on affected side
    • tilt table 20 degrees away from surgeon to improve visualization
    • exsanguinate limb
  • Incision
    • begin 2-4 cm proximal to lateral malleoulus on the posterior border of the fibula
    • extend incision down posterior fibula and bend around lateral maleolus over the peroneal tubercle
    • curve distally to a point 4 cm inferior and 2.5 cm anterior to lateral malleolus (follow the course of the peroneal tendons)
  • Superficial dissection
    1. Mobilize skin flaps
      • careful to avoid sural nerve and short saphenous vein that run posterior to the lateral malleolus
    2. Incise the deep fascia to uncover the peroneal tendons
    3. Incise the inferior peroneal retinaculum over peroneus brevis
      • must repair at end of case to prevent dislocation
    4. Incise sheath of peroneus longus
    5. Mobilize peroneal tendons and retract them anteriorly over the lateral malleolus
  • Deep dissection
    • identify calcaneofibular ligament and incise
    • locate the posterior talocalcaneal joint capsule and incise it transversly
      • inverting the foot will expose the articular surface
    • to expose lateral surface of calcaneus perform subperiosteal dissection inferiorly
Deep Dissection
  • Divide superficial and deep fascia
  • Isolate peroneal tendons
    • if necessary and there is no infection may divide tendons by Z-plasty and repair at end of case
  • Incise and elevate the periosteum below the tendons
  • Subperiostally elevate tissues (including tendons) superiorly and inferiorly off the lateral surface of the calcaneus
 

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