Updated: 11/10/2012

Posteromedial Approach to Medial Malleolus

Topic
Review Topic
0
0
Introduction
  • Allows exposure of
    • medial malleolus
    • posterior margin of the tibia
  • Indications
    • ORIF of medial malleolus fxs
    • ORIF of pilon fxs
    • ORIF of posterior malleolus fxs
 
Intermuscular interval
  • plane exists between
    • tibialis posterior tendon (tibial nerve)
    • flexor digitorum (tibial nerve)
Approach
  • Position
    • supine
    • exsanguinate limb
  • Incision
    • Make 10 cm longitudinal curved incision with concavity of incision pointing anterior
    •  
      • begin 5 cm above the medial maleollus on the posterior border of the tibia
      • curve incision distally following the posterior border of the medial malleolus
      • end incision 5cm distal to medial malleolus
  • Superficial dissection
    • Mobilize skin flaps
      • should be safetly posterior to long saphenous vein and saphenous nerve
    • Incise retinaculum behind medial malleolus in a way that it can be repaired
  • Deep dissection
    • retract tibialis posterior anteriorly
    • retract remaining structure posteriorly (neurovascular bundle, FHL, FDL)
    • perform subperiosteal dissection to expose posterior border of the tibia
      • stay on bone to avoid injury to posterior structures
Dangers
  • Tibialis posterior muscle
  • Flexor digitorum longus tendon
  • Flexor hallucis longus tendon
  • Posterior tibial artery and vein
  • Tibial nerve
.
 

Please rate topic.

Average 4.3 of 4 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
ARTICLES (1)
Topic COMMENTS (5)
Private Note